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Skills

  • Time management
  • Training program development
  • Data analysis (provider and patient metrics)
  • Change Management
  • Project leadership
  • Onboarding process optimization
  • Business operations
  • Team building
  • Patient care improvement initiatives
  • Billing best practices

Work Experiences

  • Transported Workday to 6 months customer locations.
  • Achieved a 39% increase in retention year-over-year.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated with the finance department.
  • Authored quarterly business reviews.
  • Analyzed provider satisfaction data.
  • Looked for industry trends on social media and through online sources.
  • Achieved results within three years.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Conducted 7 benchmarking studies.

Summaries

  • Adept in healthcare regulatory compliance.
  • Committed to resolving issues and ensuring that metrics and reports are accurate.
  • Achieved $18 in annual savings.
  • Achieved results through EHR technology integration.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the system business.
  • Achieved high satisfaction ratings.
  • Conducted quarterly performance reviews.
  • Senior Provider Relations Representative is a multi-talented Senior Provider Relations Representative who is consistently rewarded for planning and operational improvements.
  • Aligned provider relations with corporate goals.
  • Microsoft Excel and Tableau are two of my strongest skills.

Accomplishments

  • Developed a streamlined process for managing provider credentialing, reducing approval times by 4 days and improving provider satisfaction.
  • Developed a high-efficiency electronic claim submission process that increased provider claim acceptance rates by 50%.
  • Reduced provider appeals by 15% through an in-depth training program focused on claims accuracy and submission protocols.
  • Streamlined re-credentialing processes, reducing approval times by 17 days and increasing overall provider adherence to industry standards.
  • Improved payment turnaround time by 52% through the implementation of optimized billing and claims management protocols.
  • Successfully engaged method to increase participation in network plans, expanding membership base by 16 users.
  • Achieved 38% growth in the network by strengthening provider relationships through personalized service touchpoints.
  • Established a provider communication channel that decreased response times to inquiries by 24%, ensuring faster resolution of issues.
  • Partnered with cross-functional teams to resolve escalated provider issues, achieving a 25% improvement in issue resolution time.
  • Reduced network underperformance by 69% through implementation of key performance metrics and feedback loops for providers.

Affiliations

  • American Medical Group Association (AMGA)
  • International Association of Administrative Professionals
  • Council of Medical Specialty Societies (CMSS)
  • International Council of Nurses
  • National Association of Accountable Care Organizations (NAACOS)
  • American Medical Informatics Association
  • Healthcare Leadership Council
  • National Association of Healthcare Access Management (NAHAM)
  • Healthcare Financial Management Association (HFMA)
  • Toastmasters

Certifications

  • Health Services Management Certified Professional (HSMCP)
  • American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC)
  • Certified Public Accountant
  • Certified Healthcare Administrative Professional (cHAP)
  • Managed Care Contracting Strategies Certification by Brightline
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Managed Care Professional (CMCP)
  • Microsoft Certified Systems Engineer (MCSE)
  • Project Management Professional (PMP)
  • CompTIA A+ Technician

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