Provider Supervisor Resume Sample

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Marina Sipes
83050 Lazaro Walks,  Boston, MA
+1 (555) 628 9892

Work Experience


Supervisor / Team Lead, Provider Services
07/2015 - PRESENT
Chicago, IL
  • Responds to provider’s contract requests and inquiries
  • Reviews and amends provider’s contracts when necessary
  • Actively coach and monitor representative calls and provide on-the-spot positive and constructive feedback
  • Coach staff during the problem-solving process
  • Conduct and document individual monthly performance discussions with each direct report that communicates strengths and areas for improvement
  • Motivate staff to understand and accept change in a positive manner
  • Encourage and support career development opportunities
  • Participate in the training of new and existing staff
  • Supporting (and at times ‘Leading’) hiring, interviewing, and training efforts
Provider Enrollment Supervisor
06/2011 - 05/2015
Philadelphia, PA
  • Ensures contract SLA’s are met, such as meeting with PCP’s and Specialists on a monthly, quarterly, or annual basis to address provider panels, after hour’s availability and EMR meaningful use
  • Full Supervisory and performance management authority for those staff members who report directly to them
  • Knowledge Resource and Quality Oversight
  • Supervises, hires, trains, evaluates and disciplines employees
  • Plans, organizes and controls the daily operation of the Provider Enrollment Team
  • Provide team with communication impacting Provider Enrollment
  • Acknowledge and follow up with Coordinators/Credentialers on their questions and concerns
  • Conduct bi-weekly Team Meetings with minutes attached
  • Review and validate MyTime billing for accuracy. Approve MyTime and Leave Requests in a timely manner
Supervisor, Provider Configuration Management
07/2007 - 04/2011
Philadelphia, PA
  • Send daily absences to Team Leads/Manager
  • Work closely with Team Leads on daily assignments of the enrollment inventory
  • Review Coordinators/Credentialers work; compiles data, makes recommendations and reports necessary work assignment changes on their progress
  • Reviews Coordinators/Credentialers work for accuracy and efficiency; makes recommendations
  • Complete FMR’s timely; add new desk procedures related to FMR’s when needed
  • Assist the team’s Quality Control Analyst with the auditors Coordinators/Credentialers in performance of monthly and State audits; provides information; answers questions; explains procedures and policies as required
  • Serve as the backup for the Quality Control Analyst
  • Collaborates with the Provider Enrollment Manager in the development of new and existing desk procedures to meet future needs
  • Escalate team HR issues to Manager

Education


University of Phoenix - Rockville Learning Center
2002 - 2007
Bachelor's Degree in Business

Professional Skills


  • Strong telephonic and customer service skills. Effective presentation skills
  • Prior experience successfully managing people and projects
  • Monitors team activities to assure that staff meets service level agreements and is operating effectively and efficiently
  • Responsible for handling escalated provider issues related to enrollment and revalidation to assure timely resolution
  • Experience with provider data (demographic and / or contractual)
  • Experience with NDB
  • Experience supervisory

How to write Provider Supervisor Resume


Provider Supervisor role is responsible for training, research, health, benefits, inventory, coding, education, compliance, administration, healthcare.
To write great resume for provider supervisor job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Provider Supervisor Resume

The section contact information is important in your provider supervisor resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Provider Supervisor Resume

The section work experience is an essential part of your provider supervisor resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous provider supervisor responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular provider supervisor position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Provider Supervisor resume experience can include:

  • Strong analytical ability. MS Office/PC skills
  • Prior high-volume call-center, customer service, claims, and/or, managed care/insurance industry experience required
  • Process and operational improvement experience required
  • Leadership experience (leading, mentoring, coaching, or teaching)
  • Working knowledge of Medicaid credentialing accreditation regulations, policies and procedures
  • Providing information to Manager when requested

Education on a Provider Supervisor Resume

Make sure to make education a priority on your provider supervisor resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider supervisor experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Provider Supervisor Resume

When listing skills on your provider supervisor resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical provider supervisor skills:

  • Develops and implements process and/or operational improvements to enhance efficiency and effectiveness of enrollment and revalidation operations
  • Partner with Network Management in building effective working relationships with key providers
  • Experience with claims processing systems such as COSMOS, UNET, etc
  • Three years of experience in a healthcare claims processing organization
  • Strong knowledge of claims and adjustment process, including offsets and negative balances
  • Participation in CMS and Credentialing audits or experience conducting CMS related internal compliance audits

List of Typical Skills For a Provider Supervisor Resume

1

Skills For Provider Enrollment Supervisor Resume

  • Participate in interviewing, hiring, and training of team members. Maintain a positive work environment through employee recognition and interaction
  • Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules
  • Assists in ongoing training initiatives for all Team Members. Serve as a mentor as assigned for newly hired staff members
  • Prepare employee performance reviews. Meet with team members on a monthly basis to provide ongoing feedback and training
  • Record and maintain statistics for staff and the department. Provide coaching and development, and participate in career pathing for staff
  • Proficiency with Microsoft computer applications; including Outlook, Word, and Excel
  • In healthcare (credentialing, claims, provider networks, provider configuration)
  • Be willing to work hours necessary to ensure success of the Mississippi fiscal agent operation
  • Communicate and collaborate with internal and external professionals, including stakeholders and providers
2

Skills For Supervisor, Provider Services Resume

  • Train and update staff regarding policies and procedures
  • Review, investigate and resolve inquiries regarding provider services issues from internal and external customers
  • Investigates and responds to incoming inquiries from UPMC Health Plan customers, internal/external
  • Meets with team members on an ongoing basis to review trends, changes and quality/production results
  • Provides daily communication to team members related to processing/departmental changes
  • Provides ongoing communication to Individual Staff Members
  • Supervise and monitor ongoing performance of team members. Continually examine team performance against department standards
  • Monitors, responds and maintains Provider feedback email box
3

Skills For Supervisor, Provider Configuration Management Resume

  • Develop and maintain all staff schedules to appropriately service our contract requirements
  • Recommend for hire all new team members
  • Complete team member reviews
  • Assist in setting production goals. Regularly monitor results and communicate them to the team members; notifying Operations leadership when there are deficiencies
  • Reviews and evaluates all Claims Operations functions and documented processes, and management strategies that are in place
4

Skills For Supervisor Provider Services Call Resume

  • Promotes an environment that encourages collaboration and creativity to advance collaborative efforts within each operational unit. Maintains and encourages open communication among the various teams within the organization
  • Ensures all quantity and quality claims standards are met
  • Works hand in hand with the IT department
  • Keeps abreast of all emerging system activities as it relates to our current claims system in order to assure efficiencies in the department and determines the appropriate resources needed to respond to any increased workload
  • Prepares monthly reports which reviews the effectiveness of our Claims Unit, as it relates to the production and turnaround of claims, and provides reasonable assurance that operations are cost effective and efficient
  • Assures all Claims processing procedures meets or exceeds the data security standards set by HIPAA
  • Coordinates all audits for the claims departments and reports results as needed
5

Skills For Supervisor Provider Check Unit Resume

  • Coordinates and works with all Account Managers, as needed
  • Gain team support and motivate team to action
  • Supervises and/or advises the provider enrollment specialists (PES)
  • Provides the Enrollment Manager and other Conduent Management staff with daily/ weekly matrix that demonstrate the performance and production of the PES staff related to managing volumes of open revalidation and enrollment applications
  • Recommends and/or drafts communications relative to changes in Medicaid program and operational policies and procedures to the PES
6

Skills For Supervisor Provider Installation Resume

  • Collaborates with the NH Department of Health and Human Services (DHHS) to achieve and maintain open communications regarding provider enrollment and revalidation activities
  • Establishes and implements performance and service standards for PES
  • As a supervisor in a call center or production area
  • Exceptional verbal and written communication aptitude, with proven ability to positively influence behavior. Conflict resolution and change management competency
  • Train/coach new hires and existing staff
  • Analyze and advise management of personnel and workflow issues, and offer suggestions on resolution
7

Skills For Supervisor of Provider Enrollment Resume

  • Ensures plan pends are completed
  • Develop policies and procedures and establish goals and quality standards
  • Audit provider services calls for accuracy and compliance with standards
  • Research and resolve complex claims issues, and conduct provider and staff education
  • Acts as the liaison between Network Management, Providers and Operations
  • Conducts outbound calls to clarify follow up, and resolve inquiries from internal and external customers
8

Skills For Supervisor / Team Lead, Provider Services Resume

  • Conducts outbound service calls in accordance with departmental initiatives
  • Develop the agenda from current issues and trends that are identified and conduct regularly scheduled team meetings
  • Documents all inquiries in accordance with UPMC Health Plan guidelines
  • Establish a schedule of service calls (telephonic or personal visit) with key providers
  • Front line analyst for Staff Member questions or concerns
9

Skills For Supervisor, Provider Operations Resume

  • Functions as technical expert for their team; Ability to understand and effectively communicate information regarding multiple or complex product line or function
  • Interact professionally with all customers by telephone or correspondence to answer inquiries and resolve concerns
  • Monitors and reports on issues/trends in the unit
  • Solves problems and provides immediate feedback to Staff Members/Internal/External Customers
  • Work in conjunction with other management to allocate and adjust team resources as daily needs require. Responsible for achieving Service Level and ASA goals according to department standards as part of the Management staff
  • Expert knowledge of medical terminology, ICD-9, ICD-10, and CPT-4 coding

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