Creative professional with extensive project experience from concept to development. Resourceful with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, executive, and business audiences. Results-oriented, strategic professional with over 10 years in the Managed Healthcare industry.
Excel in Account Management, Internal Auditing and Problem Solving
Contract auditing with creative problem solving and resolution driven
Contract negotiation, review, drafting and maintenance
Proficiency in Office Management Records Management Database Creation and Administration Spreadsheets/Reports Event Management& Planning
Computer proficient in Microsoft Office, Adobe CS4 and CS5 Suite & Internet Research, Google Analytics
Contract RepresentativeMar 2013 to Current Community Partnership of Southern Arizona － Tucson, AZ
compliance with contract terms and conditions, including credentialing,
provider registration and contracts department deliverables. Provide
technical assistance to individual contractors and networks by visiting the
facility or conducting on-site training/meetings. Interpret boilerplate
special provisions and
scopes of work insuring that the Provider Type, Scope of Work and
Financial areas all match. Draft and prepare special
reports, correspondence and analyses for
review in the
areas of assignment. Monitor subcontracting agencies for contract
compliance with respect to
insurance, licensing, registration for their agency and practitioners. Develop plans
and create correspondence regarding the results and resolutions. Ensure all providers
meet minimum credentialing requirements as set forth by ADHS/DBHS,
AHCCCS and CPSA. Work in concert
with Finance to maintain current
contract related data. Develop, load and monitor subcontract
reflect any programmatic or funding
adjustment. Oversight of all Out of Area Single Case Agreements for
Level I facilities and their practitioners – agency registration, licensing,
rate load based on acuity/need. Contract denial research for appropriate claim
adjudication and/or resolution.
Claims Administrative AssistantJan 2012 to Current Phoenix Health Plan/Abrazo Health Care － Phoenix, AZMaintained and monitored staff production and created reports to track and show specific trends. Prepared correspondence, accounting and financial documents for analysis. HReviewed and provided comments on the adequacy of documents and took necessary steps to cure any deficiencies. Monitored multiple databases to keep track of all claim staff inventory tracking and trending utilizing various reports via SQL, Access and Excel ● Monitored, verified and updated staff time card using Kronos Time Clock system.
Receptionist/Office Assistant/ Administrative AssistantJan 2004 to Jan 2012 Community Partnership of Southern Arizona (CPSA) － Tucson, AZHandled multifaceted clerical tasks as the assistant to the Human Resources, Medical Management - Member and Provider Services and Contract Departments. Coordinated travel arrangements, maintained database and ensured the delivery of effective reports/queries to various stakeholders. Communicated effectively with multiple departments to plan meetings and prepare multi- faceted reports as requested. Established strong relationships to gain support and effectively achieve results. Entrusted to manage office in the supervisor's absence. Developed comprehensive, 60-page Insurance training manual that ensured consistency and effective reporting requirements per current Arizona Department of Health Services/Department of Behavioral Health Contract Standard Terms. Developed innovative PowerPoint presentations used by the internal and external staff to educate current and new staff.
BBA, Advertising/MarketingSouthwest University of Visual Arts (formerly The Art Center Design College) － Tucson, AZ, USSouthwest University of Visual Arts (formerly The Art Center Design College) - Tucson, AZ Relevant Courses: ● Market Research, Competitor Analysis, Product Positioning, Devising & Executing Marketing Campaigns ● Media Management, PR, Product Launches, Vendor Relationships ● Merchandising, Developed Trade Brochures & Catalogues, Brand Management
Carlos G. Figueroa Foundation, Board Member Graphic Design