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Provider Relations Representative Resume Example

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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
Dentaquest – Vancouver , WA
  • 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
Adt Security Services, Inc – Corpus Christi , TX
  • Managed agendas andcalendars, 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
Pyramid Hotel Group – Berkeley , CA
  • 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
MCS - Medical Card System – 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
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

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Resume Strength
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  • Formatting
  • Measurable results
  • Strong summary
  • Clear contact info
  • Typos

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

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