Ebone Winters

Healthcare credentialing and provider enrollment professional with 8+ years of direct credentialing/enrollment experience and 18+ years across healthcare administration, billing, insurance verification, patient access, compliance, and team leadership. Experienced in payer enrollment, credentialing packet preparation, provider documentation, Medicare EDI, payer portals, contracted fee schedules, Joint Commission/CMS requirements, issue resolution, auditing, training, and cross-functional support. Known for accuracy, follow-through, confidentiality, and responsive service to providers, clients, patients, and internal teams.

Provider Enrollment Specialist at Altus Biologics (2017-10 – 2025-10)

• Managed the integrity of physician credentialing and enrollment data, documents, forms, contracted fee schedules, and payer portal information.
• Prepared accurate credentialing and enrollment packets for submission to commercial and government payers, determining payer-specific documentation requirements and tracking completion.
• Updated physician fee schedules with contracted payers in Imagine Billing software and supported payer participation/status inquiries for provider and group enrollment.
• Completed, routed for signature, submitted, and tracked Medicare EDI forms for new clients; maintained the New Site Implementation Spreadsheet.
• Reviewed and maintained provider enrollment documentation and served as a point of contact for providers, clients, payers, and internal teams to resolve credentialing issues.
• Supported operational and leadership teams with special projects, payer research, portal verification, and enrollment follow-up.

Medical Biller / Credentialing Coordinator at Banks Unlimited Medical Consultants (2008-01 – Present)

• Provide medical billing and credentialing support for OB/GYN physicians and physician assistants, including provider documentation, payer follow-up, and account review.
• Review patient bills and claims for accuracy and completeness; investigate missing information, payment discrepancies, unpaid claims, and insurance/patient follow-up needs.
• Maintain critical provider enrollment and credentialing documentation, including professional licenses, certifications, background checks, and health records.
• Verify compliance with Joint Commission standards, client-specific requirements, and internal policies while safeguarding sensitive provider information.
• Apply knowledge of Medicare, Medicaid, CPT terminology, diagnostic imaging, and surgical procedures to billing and reimbursement workflows.

Verification Team Lead at Altus Infusion (2014-06 – 2017-10)

• Led insurance verification and administrative workflows for infusion services, including in-network/out-of-network benefits, authorizations, precertifications, denials, and reimbursement follow-up.
• Trained and cross-trained employees, audited staff work, monitored compliance, and created employee manuals, policies, and procedures.
• Coordinated communication among physician offices, patients, and internal teams while troubleshooting operational and IT issues.

Account Manager at Altus Biologics (2013-02 – 2014-06)

• Managed financial and administrative activities related to patient infusion, including insurance benefits verification, authorizations, precertifications, and denial appeals.
• Communicated coverage, financial responsibility, and appointment information to patients and coordinated with physician offices and internal teams.

Insurance Verification Specialist at St. Luke's Episcopal Hospital (2011-06 – 2013-02)

• Verified and entered patient demographic, clinical, insurance, and financial information to support accurate registration and billable accounts.
• Reviewed admitting documentation for compliance with Joint Commission, CMS, and health-system guidelines; developed training materials and instructed staff.

Senior Admitting Interviewer at St. Luke's Episcopal Hospital (2008-06 – 2011-06)

• Collected and validated patient demographic, medical, and financial information; assembled medical record charts and operated hospital registration systems.
• Reviewed admitting forms for regulatory compliance and resolved patient, physician, and departmental questions using strong customer-service practices.

Medical Records Clerk at NAS Jacksonville Hospital (2007-04 – 2008-03)

• Maintained, verified, and inventoried approximately 6,000 outpatient medical records and supported compliance with Joint Commission accreditation standards.

Bachelor of Science in Health Administration – University of Phoenix

Certification in Medical Administrative Assistant – Maric College (2001)