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provider relations manager resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Dedicated to 17+ years of Healthcare. Consistently Meeting and Exceeding Expectations to deliver the Very Best in Healthcare to all who give and receive Healthcare.

7+ Years Senior Provider Relations Representative

7+ Business Office

7+ years as PATIENT ACCESS REPRESENTATIVE MANAGER for a Level 1 Trauma Center.

Experience
Provider Relations Manager, 09/2022 - 09/2023
Logisticare, Inc. Atlanta, GA,
  • Participated in team meetings and provided input on deadlines, designs and enhancements.
  • Modified existing software systems to enhance performance and add new features.
  • Tested software to alleviate bugs and troubleshoot issues prior to going live.
  • Worked in team environment to produce high-quality programs and applications for Medicare Advantage industry.
  • Provided individuals and families with information and resources to connect with available programs.
  • Planned and managed different community meetings, public forums and outreach events.
  • Served in various leadership roles to plan and manage community initiatives.
  • Developed and implemented programs to fill different community needs.
  • Liaised with community members, business owners and officials to address current issues and find appropriate solutions.
  • Maintained existing and developed new partnerships with many local charity organizations to facilitate community involvement and awareness of non-profit missions and theatre events.
  • Delegated work to staff, setting priorities and goals.
  • Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
  • Recruited and trained new employees to meet job requirements.
  • Created and managed budgets for travel, training and teambuilding activities.
  • Planned and led team meetings to review business results and communicate new and ongoing priorities.
  • Assigned work and monitored performance of project personnel.
  • Evaluated individual and team business performance and identified opportunities for improvement.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Reviewed employee performance and provided ongoing feedback and coaching to drive performance improvement.
  • Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
  • Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
  • Proposed or approved modifications to project plans.
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Analyzed business performance data and forecasted business results for upper management.
  • Interviewed prospective employees and provided input to HR on hiring decisions.
  • Resolved customer inquiries and complaints requiring management-level escalation.
  • Reviewed completed work to verify consistency, quality and conformance.
Senior Provider Operations and Outreach , 08/2012 - 08/2022
Heartland Health Saint Joseph, MO,
  • Investigated concerns such as billing and claims questions on behalf of providers.
  • Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
  • Enhanced client satisfaction ratings by resolving disputes and partnering with healthcare providers to clarify issues.
  • Instructed providers on procedures and policy limitations for Medicaid and Medicare/Medicare Advantage plans.
  • Eliminated contractual risks by instructing providers and coordinating educational material distribution.
  • Participated in audit processes to ensure quality management accreditation.
  • Limited project downtime and generated client retention by adhering to practitioner contracts and resolving provider grievances.
  • Increased departmental protocol awareness by facilitating account management presentations.
  • Met cost of care budget for 4 consecutive years by negotiating rates with physicians and limiting health insurance unit costs.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Proposed or approved modifications to project plans.
  • Planned and led team meetings to review business results and communicate new and ongoing priorities.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Analyzed business performance data and forecasted business results for upper management.
  • Optimize healthcare coverage for Medicare Advantage expansion by recruiting supportive providers.
  • Collaborated with clinical and administrative staff to meet patient needs.
  • Cultivated and developed relationships with existing and potential referral sources, identified new partners, uncovered untapped opportunities and raised brand awareness.
  • Liaised with community members, business owners and officials to address current issues and find appropriate solutions
  • Supervised 25 program staff members focused on cementing connections in area to promote organizational goals.
  • Instructed providers on procedures and policy limitations for Medicaid and Medicare plans.
  • Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
  • Instructed providers on procedures and policy limitations for 3rd Party and Dsnp plans.
  • Reviewed complex and unusual claims to determine coverage restrictions.
  • Handled more than 35 calls each day with consistent high satisfaction ratings from callers.
  • Optimize healthcare coverage for Medicare Advantage expansion by recruiting supportive providers.
  • Reported liabilities and risk management concerns to supervisor for review.
  • Managed residents' activities of daily living.
  • Supported individuals' desires for dignity by compassionately assisting with personal hygiene.
  • Protected patients and staff by consistently following infection control, emergency and security procedures.
  • Built strong and trusting rapport with clients and loved ones.
  • Monitored health and well-being of clients and reported significant health changes.
  • Helped clients get in and out of beds and wheelchairs.
  • Implemented community outreach and engagement plans to reach vulnerable communities.
  • Presented clients with information, referrals and assistance accessing resources such as food, housing and transportation.
  • Performed ongoing monitoring of care plans to evaluate effectiveness, documenting interventions and goal achievements and suggesting changes accordingly.
  • Collaborated with community-based organizations and key stakeholders to address community initiatives.
  • Conducted psychosocial assessments to identify individual needs and specific social services necessary to address identified objectives and goals.
  • Maintained outreach contacts in organization's database to track progress toward base building goals.
  • Facilitated weekly meetings to discuss internal operational issues, current events, impacting community and advocacy.
  • Fostered community outreach by coordinating rapport-building events to liaise with community members.
  • Functioned as treatment team member, interpreting social, emotional and family system problems and strengths to other members.
  • Trained members to develop skills, analysis and commitment toward mission.
  • Facilitated supportive services and counseling for family members to address special concerns and ease transition during home visits.
  • Supervised team and conducted performance reviews to evaluate and offer constructive feedback.
  • Worked closely with public child welfare system staff, supervisors and court personnel to identify and mitigate barriers to timely permanency.
  • Established and executed 30 outreach strategy and growth initiatives in collaboration with senior managers.
  • Oversaw recruiting, onboarding and training of various employees.
  • Spearheaded data management and analysis to drive targeted activities and return on outreach efforts.
  • Identified new business opportunities to elevate market position and achieve goals.
  • Designed digital team to increase online engagement and social media presence of community campaigns and programs.
  • Conducted issue-based research to refine campaign context and direction.
  • Met community outreach goals through lead generation and conversion.
  • Forecasted and assessed annual, quarterly and monthly goals by analyzing report data.
  • Managed multiple 30 accounts by driving positive interactions while promoting Outreach
  • Saved over $85000 by locating and implementing alternative social programs and government grants.
  • Led regional sales meetings and education programs to enhance employee development and performance.
Lead Patient Access Representative, 03/2007 - 09/2012
Kemper Philadelphia, MS,
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
  • Collaborated with multi-disciplinary staff to improve overall patient care and response times.
  • Monitored inpatient bed use, facilities and staff to provide optimal use of resources.
  • Maintained communication and transparency with governing boards, department heads and medical staff.
  • Maintained awareness of government regulations, health insurance changes and financing options.
  • Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
  • Developed medical programs that promoted community health and research.
  • Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
  • Kept informed of advances in medicine and computerized diagnostic and treatment equipment.
  • Planned and implemented programs for health care or medical facilities supporting personnel administration and training.
  • Administered fiscal operations for accounting, budget planning, authorizing expenditures and coordinating reporting.
  • Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
  • Recruited, hired and trained new medical and facility staff.
  • Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
  • Maintained records management system to process personnel information and produce reports.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
  • Processed patient responsibility estimate determined by insurance at pre-registration.
  • Utilized screening tool for self-pay patients to determine payer sources, referring to financial counselors if necessary.
  • Registered patients by completing face-to-face interviews to obtain demographic, insurance and medical information.
  • Communicated financial obligations to patients and collected fees at time of service.
  • Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
  • Collaborated with clinical and administrative staff to meet patient needs.
  • Reported liabilities and risk management concerns to supervisor for review.
Medical Claims Processor, 01/1991 - 04/2007
Memorial Hermann Medical Center City, STATE,
  • Observed strict confidentiality and safeguarded all patient-related information.
  • Addressed patient care needs, collected vitals, dressed wounds and managed catheters.
  • Worked with registered nurses to deliver comprehensive, high-quality care to 100 patients.
  • Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
  • Collected biological samples for routine laboratory testing to assist
  • Assisted physicians with examinations and patient scans during diagnostic processes.
  • Prevented drug interactions and contributed to correct diagnosis by recording patient health information, monitoring vitals and updating patient
  • Evaluated patient care procedural changes for effectiveness and made necessary adjustments.
  • Collected and documented vital signs to track current patient conditions.
  • Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
  • Sat on Organizing Committee for the Shriners Children Hospital for Burn Victims. Organized the yearly "We are Brave" Gala. Gala raised a record million dollars for equipment, the latest treatments and talented and knowledgeable staff.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
  • Prepared medical equipment and tools to aid physician during examination and treatment of patients.
  • Administered local, inhalation or intravenous anesthetics to patients undergoing procedures.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
Education and Training
Bachelor of Science: Business Analytics , Expected in 01/2024
-
Vanguard Academy - Sacramento, CA,
GPA:
Status -
Bachelor of Science: Business Management/Business Analytics, Expected in 01/2012
-
Louisiana State University And A&M College - Baton Rouge, LA
GPA:
Status -
Bachelor of Arts: Healthcare Administration , Expected in 01/2009
-
University of Phoenix - Tempe, AZ
GPA:
Status -
Associate of Science: Health Administration, Expected in 01/2002
-
University of Houston - Downtown - Houston, TX
GPA:
Status -
Master of Arts: Health Administration, Expected in 08/2010
-
University of Phoenix - Tempe, AZ
GPA:
Status -
Skills
  • Scheduling and Coordinating
  • Work Planning and Prioritization
  • Teamwork and Collaboration
  • Administration and Reporting
  • Project Planning
  • Budget Management
  • Problem Resolution
  • Training and Development
  • Technical Proficiency
  • Revenue Forecasting
  • Goal Setting
  • Recruitment and Hiring
  • Employee Coaching and Motivation
  • Staff Training
  • Performance Tracking and Evaluation
  • Complex Problem Solving
  • Negotiation and Conflict Resolution
  • Process Improvement
  • Customer Service
  • Interpersonal Relations
  • Strategic Planning
  • Inter-Department Collaboration
  • Time Management
  • Business Development
  • Good Judgment
  • Customer Relationship Management
  • MS Office
  • Fiscal Management
  • Decision Making
  • Business Unit Oversight
  • Business Analysis and Reporting
  • Calm Under Pressure
  • Computer Skills
  • P&L Oversight
  • Shift Scheduling
  • Team Building
  • Performance Evaluations
  • Hiring and Training
  • Managing Operations and Efficiency
  • Team Leadership
  • Employee Development
  • Cost Control
  • Documentation and Reporting

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Resume Overview

School Attended

  • Vanguard Academy
  • Louisiana State University And A&M College
  • University of Phoenix
  • University of Houston - Downtown
  • University of Phoenix

Job Titles Held:

  • Provider Relations Manager
  • Senior Provider Operations and Outreach
  • Lead Patient Access Representative
  • Medical Claims Processor

Degrees

  • Bachelor of Science
  • Bachelor of Science
  • Bachelor of Arts
  • Associate of Science
  • Master of Arts

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