Provider Network Specialist, 03/2011 to 01/2017 Healthspan – Cleveland, Ohio
Responsible for researching and resolving escalated provider concerns related to claims and contract payments.
Worked closely with other departments, i.e. claims, customer relations benefits, medical management and membership accounting to identify and correct issues causing errors and inefficiencies.
Served as a Liaison between Customer Relations and Network Development. Trained Customer Service Staff to handle provider calls and created a Provider FAQ document.
Administrator for secure provider website, Carelink. Provisioned and trained new users, maintained database of active accounts, acted as Account Manager for affiliated community providers. Worked to implement enhancements to the site. Conducted onsite training and composed articles educating providers about the website 3x per year.
Assisted in managing the incoming claims pool, ensuring that vendors and providers are correctly loaded into the Epic claims platform. This reduced the volume of unidentified claims from a peak of over 3000 to a manageable daily number.
Conducted and compiled results for semi-annual Behavioral Health surveys.
Compiled Outpatient Therapy Directories.
Provider Network Coordinator, 04/2004 to 03/2011 Kaiser Permanente – Cleveland, Ohio
Worked as a phone representative handling a high volume of provider calls on a daily basis.
Diligently used patience and tact to resolve their concerns.
Researched and responded to provider issues forwarded to network development for resolution.
Customer Relations Representative, 01/2000 to 03/2004 Kaiser Permanente – Cleveland, Ohio
Worked as a phone representative handling a high volume of customer concerns and complaints.
Assisted members to understand their medical plan, benefits and to choose medical providers and locations available to them.
Assisted members with claims and premium billing issues.
Membership Accounting Representative, 03/1994 to 12/1999 Kaiser Permanente – Cleveland, Ohio
Maintained monthly premium billing accounts for 1000 employer groups in a high level production environment.
processed member enrollments, terminations and status changes accurately and efficiently to keep the accounts clean.