Field Operation Advisor Resume Example Advocate Physician Partners

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

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

Field Operation Advisor Resume Example

Resume Score: 80%

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