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
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Professional Experience
07/2010 to Current
Provider Relations ManagerModivcare － Melville , NY
- 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 ManagerKansas City Cancer Center － 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 SupervisorGentiva Health Services － 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 SupervisorGentiva Health Services － 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 RepresentativeGentiva Health Services － City , STATE
- Coordinated national vaccination clinics with Delta Airlines and Cigna Healthcare
05/1995 to 09/1998
Network Accounts Receivable RepresentativeGentiva Health Services － 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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