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Provider Network Administrator Resume Example

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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, 2011 Bellevue University － Bellevue, NE, USA
Associate of Science : Criminal Justice, 2010 Heald 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 Current Health 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 2011 Health 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.
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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

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