Provider Network Administrator Resume Example Health Net Of California

PROVIDER NETWORK ADMINISTRATOR

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

Education Degree : Health Care Management, 2011Bellevue University － Bellevue, NE, USA

Associate of Science : Criminal Justice, 2010Heald College － Rancho Cordova, CA, USA

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

Provider Network Administrator
August 2011 to CurrentHealth Net of California － Fresno, CA

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.

Customer Service Representative II
August 2007 to August 2011Health Net of California － Sacramento, CA

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.

Resume Overview

Companies Worked For:

Health Net of California

School Attended

Bellevue University
Heald College

Job Titles Held:

Provider Network Administrator
Customer Service Representative II

Degrees

Education Degree : Health Care Management , 2011
Associate of Science : Criminal Justice , 2010

Provider Network Administrator Resume Example

Resume Score: 65%

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