LiveCareer-Resume

provider network administrator resume example with 13+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary

I desire a position in health care administration/management to utilize my years of complex problem solving, communications and leadership skills. I seek to join a company that will combine my skill set and abilities with their strategy towards controlling health care cost.

Education and Training
Bellevue University Bellevue, NE Expected in 2011 Education Degree : Health Care Management - GPA :
Heald College Rancho Cordova, CA Expected in 2010 Associate of Science : Criminal Justice - GPA :
Skill Highlights
  • Six years progressive provider service experience in a health care setting.
  • Managed Medi-Cal/CMS contract administration experience.
  • Medical coding knowledge (Rev code, CPT,REV, ICD9, HCPC)
  • Ten years professional customer service experience including call-center operations.
  • Professional knowledge of Microsoft Office products
  • Experience with ACA legislation, emerging markets and health exchanges.
Professional Experience
Centene Corporation - Provider Network Administrator
Troy, MI, 07/2011 - Current
  • Maintains provider databases, including managed Medi-Cal products.
  • Maintained records and files and distribution of materials to Provider Network staff.
  • Coordinate and facilitates required annual Joint Operating Committee Meeting at the PPG sites and conducts physician, hospital and/or ancillary meetings as necessary.
  • Assist contract manager with active negotiations as well as maintain amicable professional relationships to support future negotiations.
  • Responsible for timely and professional initial response to providers and other Health Net associates and refers concerns or issues to appropriate Provider Network Management.
  • Conducts periodic site visits to provider offices in order to meet regulatory requirements.
Iconma, L.L.C. - Customer Service Representative II
IL, State, 07/2007 - 07/2011
  • Researched and analyzed complex claim matters and located opportunities to streamline service for increased efficiency.
  • Provided correspondence for coordination of benefits and managed Medi-Cal lines of business.
  • Exceeded established departmental goals for quality assurance.
  • Contacted physician groups, IPA's and ancillary providers to assist with membership issues.
  • Responds to routine inquiries on multiple products relating to eligibility, pharmacy, claims, and provider services.

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Resume Overview

School Attended

  • Bellevue University
  • Heald College

Job Titles Held:

  • Provider Network Administrator
  • Customer Service Representative II

Degrees

  • Education Degree
  • Associate of Science

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