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Skills

  • Insurance billing
  • First Aid/CPR
  • Account portfolio management
  • Billing issue mitigation
  • Performance metrics analysis
  • Project organization
  • Inventory management
  • Quality improvements.
  • Credentialing process refinement
  • Administrative support

Work Experiences

  • Followed safety protocols to prevent accidents and disease spread.
  • Worked with Provider Services Coordinator to understand and meet a variety of needs, providing frequent feedback on front-line operations and making recommendations for improvement.
  • Answered 4 phone calls per several months to assist customers.
  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Achieved a 66% increase in retention.
  • Assisted in the implementation of social service programs for program and category individuals.
  • Achieved a 15% drop in repeat issues.
  • Achieved a 35% decrease in onboarding time.
  • Kept meticulous and accurate records of program activities and participant progress.
  • Assisted in the creation of metric procedures.

Summaries

  • Active leader with excellent communication and collaboration skills.
  • A results-oriented Provider Services Coordinator with in-depth experience in resolving claim issues and increasing efficiency, ensuring providers receive timely and accurate resolutions.
  • Strategic thinker with expertise in performance reporting.
  • Results-oriented Miscellaneous professional with project management, performance reporting, and project management strengths.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • Performance reporting Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • Well-versed in team leadership and always looking for new ways to improve strategies and help.
  • Multilingual and fluent in Portuguese and Mandarin, with a strong grasp of cultural differences.
  • HubSpot and Workday experts with exceptional interpersonal skills.
  • Achieved 98% on-time renewals for 6 healthcare providers.

Accomplishments

  • Successfully coordinated large-scale provider events resulting in 33% increase in network engagement and positive feedback.
  • Collaborated with the compliance team to audit provider service records, ensuring 100% adherence to company and HIPAA regulations.
  • Collaborated with the billing and compliance departments to mitigate provider claim rejections, improving overall claims payment accuracy by 61%.
  • Prepared monthly performance reports, providing actionable insights to upper management, which supported a 45% increase in provider satisfaction.
  • Optimized the complaint resolution system, achieving a 24-hour turnaround for provider cases and reducing escalations by 33%.
  • Led cross-functional collaboration efforts that resulted in an 18% enhancement of provider claim refinement processes in 2024, driving higher accuracy and efficiency.
  • Actively supported the resolution of escalated billing issues by negotiating timely claims adjustments, closing cases within the past year% of standard timeframe.
  • Developed and documented training materials to support providers in using new system features, reducing onboarding time and improving usability by 26%.
  • Implemented a comprehensive provider feedback system, achieving a 20% faster resolution rate of escalated provider cases within the first quarter.
  • Worked directly with providers to implement a customer-first approach that led to a 48% increase in satisfaction survey scores year-over-year.

Affiliations

  • Board Member, Healthcare Providers Directory Management Council, procedure
  • Member, Medical Group Management Association (MGMA) procedure
  • Active Member, Society of Healthcare Professionals in Provider Relations, category
  • Facilitator, Webinar on Effective Provider Query Response, 2017
  • Certified in Lean Healthcare Process Optimization, CPA, 2018
  • Certified in Healthcare Provider Onboarding Strategies, procedure, 2021
  • Task Force Member, National Provider Sustainability Initiative, standard
  • Committee Member, Healthcare Quality Improvement Association, category
  • Attendee, Annual Conference on Provider Relations and Network Management, 2019
  • Attendee, Healthcare Provider Relations Summit, 2018

Certifications

  • Certified in the Governance of Enterprise IT (CGEIT)
  • Certified Health Insurance Executive (CHIE)
  • Healthcare Data Analyst Certification (CAP) by Summit Group
  • Certified Healthcare Access Manager (CHAM)
  • Google Certified Professional Cloud Architect
  • SHRM Certified Professional (SHRM-CP)
  • Certified Professional in Healthcare Information and Management Systems (CPHIMS)
  • Certified Compliance Professional (CCP)
  • Certified Professional Coder (CPC)
  • Certified Professional in Healthcare Risk Management (CPHRM)

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