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managed care contract manager resume example with 11+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

Experienced in reviewing financial documents and digital records. Effective at directing, monitoring and inspiring team members to complete accurate and timely investigations and reports. Talented in training employees, solving complex problems and making sound decisions.

Skills
  • Written and verbal communication
  • Organization and Time management
  • Critical thinking
  • Conducting Investigations
  • Audit
  • Applicable Laws And Regulations
  • Claims Analysis
  • Provider Monitoring
  • Information gathering
  • Account Reconciliation
  • Data management
Work History
Managed Care Contract Manager, 05/2016 - 07/2021
Phelps County Regional Medical Center Saint James, MO,
  • Referred over 50 clients per day to appropriate team members, community agencies and organizations to meet treatment needs.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.
  • Prepared variety of different written communications, reports and documents to ensure smooth operations.
  • Worked closely with Patient Financial Services and contracted payors to maintain optimum levels of communication to effectively and efficiently complete projects while collecting 4.5 million dollars in additional revenue for UF Health Jacksonville.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity by 75%.
  • Work with forty-one interdepartmental team members to analyze rate proposals from MCO's and offer direction and recommendations to management during negotiations.
  • Researched and provide answers to contractual questions posed by various departments within UF Health.
  • Worked with internal staff to assemble and analyze audit reports to ensure accurate development and maintenance of provider networks and reimbursement contracts, and compliance by MCO's.
  • Supported Provider Enrollment management and staff to provide assistance if needed on lowering enrollment errors, timelines, while successfully enrolling 600 to 800 providers annually.
  • Monitored/track HEDIS compensation annual collection of 500k - 1 million dollars annually.
  • Review risk contract model agreements lowered by 10%.
  • Supported Provider Enrollment Management Team on negotiating Delegated Agreements.
  • Notified MCO's of annual charge master increases and any other material changes within UF Health, and work with MCO's to implement necessary changes or updates (e.g., payment discounts, etc.).
  • Worked cohesively with other areas of Managed Care Department to identify and resolve provider, network, and contractual issues, as they arise.
  • Build, foster positive working relationships with contracted and non-contracted MCO's, as well as various departments within UF Health and contracted payors.
  • Provide regular updates to management on status of contractual compliance of participating MCO's keeping management apprised of non-contracted MCO's as well.
Financial Analyst, 01/2012 - 05/2016
Bartell Drugs Sammamish, WA,
  • Managed, tracked and monitored financial updates, watch lists and insurance files for accounts exceeding 1 million dollars.
  • Collected data and developed detailed spreadsheets to identify trends and create revenue, profitability and expense forecasts increasing underpayment collections 25%.
  • Developed forecasting tools to analyze revenue variance, business pipeline and industry trends to decrease overpayments to contracted payors by 50%.
  • Developed and deepened client relationships to cement profitable partnerships.
  • Educated clients on factors affecting successful capitalization such as investment levels, funding sources and strategic timing.
  • Interacted with 12 contractors, 4 subcontractors and 6 suppliers to guide cost analysis process by establishing and enforcing policies and procedures.
  • Reviewed financial reports and streamlined operations to increase productivity by 80% and company profits increased 30%.
  • Used EPIC to create reports and recommended courses of action to upper management.
  • Handled internal and external inquiries and complaints submitted by accounts payable clerk, finance director and other department heads, providing outstanding customer service when resolving issues.
Epic Principle Trainer, 02/2010 - 03/2014
UF Health Jacksonville City, STATE,
  • Used EPIC to design training for new and existing employees and increase company retention and productivity rates 85%.
  • Analyzed company training methods and made adjustments to rectify issues, increase efficiency and exceed training goals, resulting in better performance and less errors.
  • Developed lesson plans, instructional materials and written practice tests for Patient Financial Services and Admissions staff training courses.
  • Coordinated workshops for employees to better understand company mission, streamlining daily activities and aligning worker and company priorities.
  • Developed and implemented updating training programs for all new hire employees.
  • Monitored day-to-day activities of UF Health Jacksonville organization and employees, noting areas needing improvement and implementing plans for rectification.
  • Liaised between executives and entry-level workers, facilitating smooth communication and successfully achieving boost in employee morale and fostered team work.
  • Developed new training programs such as online modules, interactive software, language labs and online programs and provided ongoing training to staff.
Education
Associate of Arts: EPIC And Electronic Medical Records (EMR), Expected in 04/2013
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EPIC University - Madison, WI,
GPA:
Status -
  • Completed professional development in Adult Learning Strategies
  • Relevant Coursework Completed: Electronic Medical Records Build and Implementation & EPIC Implementation and build on Single Billing Offices (SOB) and Resolute Hospital Billing.
  • Professional development completed in Management Strategies
Certifications

Certified EPIC Principle Trainer for Single Office Billing and Resolute Hospital Billing

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Resume Overview

School Attended

  • EPIC University

Job Titles Held:

  • Managed Care Contract Manager
  • Financial Analyst
  • Epic Principle Trainer

Degrees

  • Associate of Arts

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