Provider Relations Representative Resume Example Company Name

PROVIDER RELATIONS REPRESENTATIVE

Professional Summary

Seasoned Provider Relations Representative possessing in-depth knowledge of various insurance plans and policies. Expertise in handling high volume of calls, efficiently resolving disputes and identifying ways to improve processes. Proficient in [Software] and [Software]. Communicative and detail-oriented individual with excellent interpersonal abilities.

Skills

Provider relationship management
Service optimization
Strategic Business Relationships
Educational Presentations
Relationship development
Provider orientations

Provider support
Workflow Analysis
Data Analysis
Network development
Lead prospecting

Work History

Provider Relations Representative, 11/2019 to 03/2020
Company Name – City, State

Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
Developed new business by networking with prospects and valuable customers at [Type] and [Type] events.
Developed and utilized [Type] reports to assist leadership with key decisions and outperformance of operational targets.
Initiated physician and hospital orientations to support ongoing education of health care provider community.
Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
Enhanced productivity levels by anticipating needs and delivering outstanding support.
Assisted various departments with change by communicating new improvement plans and expectations.
Tracked and analyzed reports to determine needed improvements.
Generated reports of findings to help management with making key decisions.
Evaluated performance and policies against metrics.
Worked with [Type] customers to understand needs and provide [Type] service.

Vice President of Medicare Network, 01/2011 to 11/2019
Company Name – City, State

Managed agendas and calendars, boosting productivity and improving organizational initiatives.
Successfully juggled multiple projects simultaneously to aid executive leaders.
Interpreted management directives to define and document administrative staff processes.
Adapted to workflow changes and implemented continuous process improvements to overcome obstacles.
Established and updated work schedules to account for changing staff levels and expected workloads.
Assisted executive leaders in decision-making procedures by creating daily reports to advise leaders on corrective actions and process improvements.
Assessed personnel performance and implemented incentives and team-building events to boost morale.
Confirmed accurate completion of forms and reports for admission, transfer and/or discharge of each resident.
Conducted health programs such as Medicare Physicians Network.
Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
Screened and transferred incoming calls, took down messages and transmitted information and documents to internal personnel as point of contact for office.
Prepared daily Hospital Admissions and Discharge reports to assist business leaders with key decision making and strategic operational planning.
Developed revisions to [Type] systems and procedures by evaluating operational practices and identifying improvement opportunities.
Entered and maintained departmental records into company database using [Software].
Networked with industry professionals to foster partnerships and identify new and improved [Type], [Type] and [Type] solutions.
Codified office structures and processes to promote teamwork and performance.
Developed team communications and information for [Type] meetings.
Maintained excellent attendance record, consistently arriving to work on time.

Administrator, 08/2006 to 08/2010
Company Name – City, State

Managed agendas and calendars, boosting productivity and improving organizational initiatives.
Successfully juggled multiple projects simultaneously to aid executive leaders.
Managed payroll, transactions, invoicing and budgeting to decrease financial inconsistencies.
Managed bi-weekly payroll for over [Number] employees, as well as insurance matters, workman's compensation and compliance reporting.
Maintained accurate, current and compliant financial records by monitoring and addressing variances.
Directed hiring and recruitment of personnel in all departments.
Conducted health programs such as Vaccinations, Dental Care Facilities and Medicaid Services Clinic.
Devised and introduced initiatives and projects to maintain or improve existing facilities, allowing for maximization of capital component of Medicaid's per diem rate.
Organized and facilitated [Number] department head meetings weekly, discussing current census, admissions and discharges.
Supervised team of [Number] pharmacy technicians.
Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
Created customized care plans, working with hospital staff and families to assess and meet individual needs.
Scheduled surgeries, managed pre-certifications and verified insurance coverage.
Generated and reviewed incident reports, including employee write-ups, actualizing appropriate corrective action plans to mitigate ongoing and potential situations.
Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
Offered patients and patrons information on various immunizations including flu, DTaP and HPV vaccines.
Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.

Sales Coordinator, 02/2003 to 07/2006
Company Name – City, State

Created effective marketing and trade show material to educate and engage prospective clients in [Product or Service] offerings.
Offered each customer top-notch, personal service and polite support to boost sales and customer satisfaction.
Established working relationships with clients by organizing various events.
Compiled client profiles and entered information into operating system.
Created documents recommended courses of actions to assist upper management in complex decision-making issues.
Organized sales paperwork, presented proposals and finalized contracts valued more than $[Amount] on average
Worked alongside retail representatives to boost sales by enhancing product presentations and advertising collateral.
Produced contracts, reports, letters, and proposals for clients.
Set up appointments with potential and current customers to promote new products and services.

Education

Bachelor of Applied Studies: Liberal Studies, 05/1995
Pontifical Catholic University of Puerto Rico - City, State

Phi Delta Gamma Fraternity

MBA: Human Resources Management, 05/2006
University of Phoenix Puerto Rico - City

Graduated with 3.75 GPA
Graduated cum laude

Resume Overview

School Attended

Pontifical Catholic University of Puerto Rico
University of Phoenix Puerto Rico

Job Titles Held:

Provider Relations Representative
Vice President of Medicare Network
Administrator
Sales Coordinator

Degrees

Bachelor of Applied Studies : Liberal Studies , 05/1995
MBA : Human Resources Management , 05/2006

Provider Relations Representative Resume Example

Resume Score: 80%

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