provider network support specialist ii resume example with 6+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Professional Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Skills
SOFTWARE/SKILLS
Microsoft Office Suite: Excel, Word, Outlook, PowerPoint, Project, SharePoint
|Skills: Team leadership & Motivation | Problem-solving | Results-Driven | Relationship Building | Flexible | Time Management | Communication | Event Management | CMS Compliance | Data Entry | Data Analytics | Systems Administration | Data Management | Managed care | Client Relationships | Project Coordination |Provider support |Network support |Provider orientations |Administrative support experience | Medicare Compliance | Managed Care | Medicaid |Data Entry
Work History
11/2022 to CurrentProvider Network Support Specialist IICentene Corporation | Corpus Christi, TX,
Promoted & appointed to implement the new Provider Engagement Operation Model training and facilitate said training to company staff
Focusing on ADA Accessibility, charged with developing a tracking system used to track individual employee activities & captured information during provider office visits
Activities include reviewing documentation, inspecting the interior/exterior of the facility, and maintaining safety, health & environmental compliance
Collaborate with internal departments to ensure that network operations are aligned with overall organizational goals and provider related issues and concerns were resolved
Monitor provider performance to ensure compliance with quality and cost-effective standards
Develop and maintain relationships with healthcare providers to ensure network adequacy.
Improved overall user experience by 25% through support, training, troubleshooting, improvements and communication of system changes.
12/2020 to 11/2022Provider Network SpecialistCentene | City, STATE,
Act as liaison between providers and the health plan to enhance the business relationship
Led UAT testing, charged with facilitating training and verifying that claims process is following user manuals and company regulations
Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
Assessed KPIs, tracked trends, system requirements, use & failures, and made recommendations for software & program enhancement and user experience improvement
Improved speed & ease of onboarding time by 25% by listening to provider complaints and feedback and making updates to onboarding education process resulting in increased engagement & satisfaction
09/2020 to 12/2020Staffing / Event Program ManagerOptum | City, STATE,
Planned, organized, and managed the staffing program for Covid-19 testing including scheduling, health & safety requirements, and training & development
Managed funding and headcount for assigned testing sites per state funding program management guidelines
Designed projects and programs based on forecasted needs
Tracked activities, planned resources, conducted risk analyses, executed programs, and engaged with stakeholders to report program operations and success based on collected data.
03/2017 to 09/2020Provider Data ManagerUnitedHealthcare | City, STATE,
Functioned as Subject Matter Expert (SME) relaying the NDB perspective when leading responses & actions to internal/external requests and ensuring program needs met set guidelines and objectives
Responsible for ensuring that provider data is accurate and up to date in organization’s databases
This includes verifying provider credentials, contact information, and network affiliations
Increased provider compliance to 95% by fulfilling CMS (Center for Medicare & Medicaid Services) regulatory requirements targets.
Applied effective time management techniques to meet tight deadlines.
Education
Expected in 2016 to to Master of Science | Multidisciplinary Human ServicesCapella University, Minneapolis, MNGPA:
Expected in 2011 to to Bachelor of Arts | Human Communication StudiesShippensburg University of Pennsylvania, Shippensburg, PAGPA:
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.