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Field Operation Advisor Resume Example

Resume Score: 80%

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FIELD OPERATION ADVISOR
Professional Summary

Forward-thinking professional offering more than 20 years of experience working in fast-paced environments. Skilled in Population Health Management, Value Based Programs, ACOs, and Government Programs. Extensive training in a Clinically Integrated Network, known for reliability and strong Manged Care knowledge.

Work History
Field Operation Advisor, 01/2014 - CurrentAdvocate Physician Partners, Rolling Meadows, IL
  • Regularly meet with physicians within assigned territory to build engagement, including crucial/difficult conversations when necessary.
  • Provide subject matter expertise, consultation and education to physician members by establishing and maintaining strong relationships with physicians and their practice.
  • Manage monthly visits to 22 aligned/private Primary Care practices and quarterly on-site visits to 62 aligned/private Specialty Care practices.
  • Educate Physician members healthcare delivery and its transformation. Advise and educate on various topics such as; Clinical Integration performance, Population Health Management strategies and programs, identify and work to implement best practices, and managing risk and quality performance.
  • Support Good Shepherd PHOs (Physician Hospital Organization) achievement and success through active engagement, frequent communication, and collaboration with Senior Leadership and PHO Board of Directors.
  • Manage end of year analysis of quality performance targets and achievement to aide in maximizing performance.
  • Monitor and identify opportunities to improve quality and financial performance.
  • Effectively managed various tasks including network management, new physician orientation, change management, and trainer.
  • Analyze workflows and collaborate with leadership towards improvements and standardizations.
Provider Relations Representative, 01/2010 - 01/2014Advocate Physician Partners, Rolling Meadows, IL
  • Worked with new and existing practices to comply with Managed Care guidelines and Clinical Integration performance.
  • Responsible for increasing physician engagement and aide in maximizing Clinical Integration performance
  • Fostered strong, positive relationships with key Physicians by coordinating, facilitating and leading partnership meetings and identifying on-site training opportunities.
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution, and forwarding requests to appropriate departments.
  • Managed physician meetings to support ongoing success in various program and quality metrics.
  • Identified network gaps and collaborated with hospital partners to fill deficiencies.
  • Researched and resolved physician disputes and billing discrepancies to maintain customer satisfaction with Physicians partners.
  • Developed, reviewed and prepared provider educational material to increase performance outcomes.
  • Collaborated with physician members and their staff to better understand customer needs and recommend appropriate solutions.
  • Manage the credentialing process for new and existing physician members.
Supervisor, 01/2007 - 01/2010Advocate Health Partners, Mt. Prospect, IL
  • Oversaw and optimized work of 10 Customer Service Representatives performing high-quality work.
  • Revitalized operational structures and procedures to successfully control number of abandon calls, enhance output and boost overall quality.
  • Enhanced training programs to strengthen employee knowledge and promote new managers from within.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organized workflows to meet any daily demand.
  • Interviewed, hired and trained new employees.
  • Provided supportive link between external customers and internal operations.
  • Handled customer complaints, resolved issues and adjusted policies to meet changing needs.
  • Measured team performance and reported metrics to leadership team members.
  • Successfully managed high call volumes of patient-facing interactions and established strong rapport with physicians and medical staff.
Auditor, 01/2004 - 01/2007Advocate Health Partners, Mt. Prospect, IL
  • Developed and organized Advocate Physician Partner's appeals unit
  • Reduced and maintain the claim appeals inventory
  • Worked with management to discuss errors and develop a corrective action plan.
  • Gathered and analyzed claims data to determine improvement efforts.
  • Performed strategic planning, execution and finalization of audits.
  • Prepared working papers, reports and supporting documentation for audit findings.
  • Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
  • Developed and enforced audit policies
  • Identified management control weaknesses and provided value added suggestions for remediation.
  • Determined effectiveness of current control structures.
Education
B.S, Business – Health Care Management, 05/2019
Western Governors University - Salt Lake City, UT
Additional Information
  • CompTIA Project + Certified
  • 2004 MVP Value Leader award for Partnership Awarded by Advocate Health Care
Skills
  • Ability to focus and achieve strategic directives.
  • Substantial analytical, problem-solving, and troubleshooting skills.
  • Strong team-building and leadership qualifications.
  • Accomplished skills in relationship management.
  • Strong knowledge of hospital and physician operations and services impacted by Manged Care and Health Care Reform.
  • Proficiency in MS Office
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Resume Overview

Companies Worked For:

  • Advocate Physician Partners
  • Advocate Health Partners

School Attended

  • Western Governors University

Job Titles Held:

  • Field Operation Advisor
  • Provider Relations Representative
  • Supervisor
  • Auditor

Degrees

  • B.S , Business –Health Care Management 05/2019

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