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| Desired Industry: Healthcare |
SpiderID: 76100 |
| Desired Job Location: Nolensville, Tennessee |
Date Posted: 9/3/2015 |
| Type of Position: Full-Time Permanent |
Availability Date: Immediately |
| Desired Wage: 130000 |
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U.S. Work Authorization: Yes |
| Job Level: Management (Manager, Director) |
Willing to Travel: Yes, 25-50% |
| Highest Degree Attained: Bachelors |
Willing to Relocate: Yes |
Objective:
Multifaceted, well-organized, and
customer-oriented professional, offering
progressive experience in network
services management and provider
relations within various
industries. Effective at collaborating
with all levels of individuals to ensure
the delivery of excellent customer
service. Versatile, hands-on leader and
team player; with strong organizational,
contract negotiation, and strategic
implementation expertise. Recognized for
in-depth knowledge of core business
operations, regulatory compliance,
problem resolution, and process
improvement. Proficient with Microsoft
Office Suite (Excel and Word), Microsoft
Access, and Contract Management Systems.
Experience:
Professional Experience
Wellcare Health Plans (formerly Windsor
Health Plan)
Director of Network Management—
Brentwood, TN 2010–2015
Provided expert oversight to the
department, responsible for implementing
physician contracting, network
development, and provider relations and
operations.
Observed strict compliance with provider
access standards established by the
Center for Medicare & Medicaid Services
(CMS) by formulating departmental
policies and procedures.
Conceptualized and executed strategies,
in coordination with Medical Management
and Sales departments to effectively
meet market growth, medical management,
and cost containment
targets.
Successfully obtained company targets
through aggressive negotiation and
management of cost-effective IPA primary
care, specialist, and ancillary
contracts.
Earned promotion from supervisor to
manager in six months; then subsequently
to the director position within two
years.
Provider Relations Manager—Brentwood, TN
2008–2010
Played leadership role within the
Provider Relations Department including
establishment of goals and management of
daily business operations.
Facilitated in-depth analysis of
provider data and developed action plans
to effectively manage medical cost.
Organized and supervised new client
orientations, issue resolution, and
marketing activities associated with the
providers.
Employed analytical skills in creating
and revising the provider education
material for staff and clients annually.
Provider Relations Supervisor—Little
Rock, AR 2008–2008
Rendered direct supervision to a team of
provider relations representatives on
their daily tasks within Arkansas.
Spearheaded large group orientations for
newly contracted and established
providers; as well as appointments,
presentations, and member enrolments, in
coordination with local
sales agents.
Managed staffing requirements for the
provider relations representatives,
which entailed hiring, training, and
supervising three new talents; earned
fast-track promotion after
significant contributions in leading the
team to be considered as the strongest
provider relations team within the
company.
Unison Health Plan, Memphis, TN
Provider Relations Representative
2006—2008
Offered hands-on support with the
establishment of a provider network for
prospective and existing lines of
business by representing affiliated
health plan in the negotiation of
provider agreements.
Built and cultivated strong business
relationships with contracted providers
through excellent customer service and
issue resolution skills.
Conferred with providers to develop
proper protocols, ensuring appropriate
submission of medical claims/billing.
Provided assistance to providers in the
credentialing of process necessary to
meet National Committee for Quality
Assurance (NCQA) standards.
Acted as an unofficial team lead for
other provider relations representatives
in recognition for exemplary ability to
quickly absorb new materials and clearly
deliver newly-
learned information to clients.
Accredo Health Group, Memphis, TN
Patient Account Representative 2003—
2006
Took charge of managing and reviewing
patient accounts to ensure billing and
payment accuracy.
Dealt with the preparation and
submission of healthcare claims and
payment inquires to health plans.
Education:
Bachelor of Science in Psychology: 2003,
Arkansas State University, Jonesboro, AR
Affiliations:
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Skills:
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Additional Information:
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Reference:
Available upon request.
Candidate Contact Information:
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