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Provider Relations Manager Resume Example

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PROVIDER RELATIONS MANAGER
Professional Summary

Highly motivated and successful professional of healthcare accounts receivables, with experience in both practice management as well as payer/provider relations. Extensive experience in managing multiple projects with competing priorities. Confident and experienced public speaker.

Education and Training
1999
Penn Valley Community College － City, State
1995
University of Missouri － City, State
1992
Belton High School － City, State
Skill Highlights
  • Independent
  • Tenacious
  • Goal Oriented
  • Self Disciplined
  • Sensible
  • Decisive
Professional Experience
07/2010 to Current
Provider Relations ManagerCompany Name － City, State
  • Accountable for full range of provider relations and service interaction within UnitedHealth Group, including working end-to-end claim resolution, ease of provider portal, training and development of external education programs.
  • Identify gaps in Network composition and services to assist Network contracting in prioritizing needs.
  • Design and implement programs to build and nurture positive relationships between the health plan, providers, and practice managers.
  • Supporting internal business partners to achieve shared goals within multiple product lines including Commercial, Medicare, Medicaid, and Tricare.

Accomplishments: 

  • Improved provider satisfaction scores from 55% to 78%
  • Reduced the year over year aggregate service issue volume by 40%
  • Resolved 99% of issues within 20 days of receipt
  • Employee engagement vital signs scored 100% satisfaction, exceeding department and corporate averages
  • Awarded contracts to manage KS Medicaid effective 1/1/13 and Tricare effective 4/1/13; resulting in team expansion, extended provider scope support, and extensive communication and collaboration with business partners throughout the states of MO and KS.
01/2007 to 07/2010
State Business ManagerCompany Name － City, State
  • Recruit, hire, and manage business office staff of 19 individuals.
  • Monitored aged balances for approximately $23M, ensuring timely and efficient resolution.
  • Prepared monthly financial analysis on accounts receivables, collection percentages including extensive focus on payer & denial trends.
  • Created and implemented reimbursement policies and procedures, ensuring compliance with appropriate industry regulations

Accomplishments: 

  • Decreased credit balances from $1Million to $100k
  • Decreased Days Sales Outstanding from 55 to 27 while increasing collections and reducing bad debt write off
  • Reduced staff by 50% while increasing efficiency
  • Reduced receivables over 120 days from 30% to 5%, exceeding company expectations by 50%
  • Created and implemented goal enriched environment and shifted receivable focus from 180 days to 60 days

06/2004 to 01/2007
Financial Services Unit, Accounts Receivable SupervisorCompany Name － City, State
  • Supervise, mentor, and encourage staff of 8 by offering consistent and supportive feedback, assisting with goal setting while clearly defining expectations.
  • Responsible for timely and accurate billing and collections of approximately 3.5M for fourteen nursing branches in four states.
  • Developed positive relationships with business partners through extensive communication and collaboration

Accomplishments: 

  • Due to new business in one month's time, total accounts receivables portfolio increased by $1Million while receivables over 60 days declined from 30% to 20 %
  • Total credits kept to less than 5% of accounts receivables.
  • Maintained team accuracy of 99%
  • Awarded Gentiva's National “Gold” award for the individual in the company who best exemplified “TEA” (Timeliness, Efficiency, Accuracy)

04/2000 to 06/2004
CareCentrix Infusion Claims and Customer Service SupervisorCompany Name － City, State
  • Supervised staff of 18 individuals in satellite claims processing/call center operation.
  • Maintained inventory control of claims; responsible for managing the adjudication of infusion claims.
  • Collaborated with Regional Care Centers to ensure proper creation of authorizations

 

Acomplishments: 

  • Days claims outstanding maintained at 10 days or less
  • Awarded Gentiva's Customer Service Award in December 2001
  • Claims adjudication average of $12Million per month with 98% accuracy
09/1998 to 02/1999
Clinical Business Solutions, Account RepresentativeCompany Name － City, State
  • Coordinated national vaccination clinics with Delta Airlines and Cigna Healthcare
05/1995 to 09/1998
Network Accounts Receivable RepresentativeCompany Name － City, State
  • Researched patient accounts, verifying accuracy of adjustments and payment applications.
Affiliations

GKCMMA, Greater Kansas City Medical Manager Association

- Payer Committee Member

- Business Partner


KHA, Kansas Hospital Association

- Technical Advisory Group Member

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Resume Overview

School Attended

  • Penn Valley Community College
  • University of Missouri
  • Belton High School

Job Titles Held:

  • Provider Relations Manager
  • State Business Manager
  • Financial Services Unit, Accounts Receivable Supervisor
  • CareCentrix Infusion Claims and Customer Service Supervisor
  • Clinical Business Solutions, Account Representative
  • Network Accounts Receivable Representative

Degrees




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