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
Expected in 2011
Education Degree: Health Care Management Bellevue University - Bellevue, NE GPA:
Expected in 2010
Associate of Science: Criminal Justice Heald College - Rancho Cordova, CA GPA:
Skill Highlights
Six years progressive provider service experience in a health care setting.
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.
07/2007 to 07/2011
Customer Service Representative IIIconma, L.L.C. – IL, State,
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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