provider relations representative resume example with 17 years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary

Well-organized Administrative professional bringing excellent multi-tasking abilities developed over 17 years of Health Industry experience. Commended for consistently driving team success with knowledgeable enforcement of company procedures. Proficient in Microsoft Office with expertise in database management. I posses a depth knowledge in administration of Medicare Network System, efficiently resolving disputes and identifying ways to improve processes. Communicative and detail-oriented individual with excellent interpersonal abilities.

  • Provider relationship management
  • Strategic Business Relationships
  • Relationship development
  • Provider orientations
  • Provider support
  • Workflow Analysis
  • Data Analysis
  • Network development
  • Reporting and documentation
  • Administration and management
  • Policy implementation
  • Workflow planning
  • Healthcare program management
  • Continuous improvement management
  • Interpersonal and written communication
Work History
11/2019 to 03/2020 Provider Relations Representative Common Spirit | Clive, IA,
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
  • Developed and utilized metrics reports to assist leadership with key decisions and out performance of operational targets.
  • Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings to improves the goals.
  • Assist physicians over various departments communicating new improvement plans and expectation to reach objectives and politics in compliance of medicare insurance
  • Tracked and analyzed metrics reports to determine needed improvements.
  • Generated reports of findings to help providers with making key decisions.
  • Monitor status of individuals with chronic health concerns (metrics for Stars report)
01/2011 to 11/2019 Vice President of Medicare Network The Kemtah Group | Griffin, GA,
  • Managed agendas and calendars, boosting productivity and improving organizational initiatives.
  • Interpreted management directives to define and document administrative staff processes.
  • Adapted to workflow changes and implemented continuous process improvements to overcome obstacles.
  • Assisted group president in decision-making procedures by creating daily reports to advise executives leaders on corrective actions and process improvements.
  • Assess administrative personnel and his performance to implement and team-building events to boost morale.
  • Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
  • Prepared daily Hospital Admissions and Discharge reports to assist health providers of the group with key decision making and strategic operational planning.
  • Networked with industry professionals to foster partnerships and identify new and improved best practices of health services as specialty health networks.
  • Support to the personnel of medical offices structures and processes to promote teamwork and performance.
  • Developed teamwork communications and information for providers meetings.
  • Organize and managed physicians contracted directly related to strategic mission of healthcare system.
08/2006 to 01/2011 Administrator Columbus Hospitality | Ocala, FL,
  • Medical group administration that provides medical services to patients subscribing to the health plan of the government of Puerto Rico.
  • Managed agendas and calendars, in different departments inside of clinics boosting productivity and improving organizational initiative.
  • Conducted health programs such as Vaccinations, Dental Care Facilities and Medicaid Services Clinic.
  • Organized and facilitated weekly department meetings (medical staff, nurses, vaccination nurses, administrative assistants, and secretaries) discussing issues about medicaid health plan patients.
  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
  • Authorize and supervised scheduled cataract surgeries, managed pre certifications, and insurance coverage.
  • 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.
  • Coordination of health clinics, to offer vaccination services to the population, such as Influenza, Pneumonia and vaccines for infants.
  • Routine inspections of the facilities, identifying areas that need improvement and eliminating risks to personnel. In compliance with state and federal regulations (OSHA)
02/2003 to 07/2006 Sales Coordinator MCS - Medical Card System Of Puerto Rico | City, STATE,
  • Established working relationships with clients by organizing various events.
  • Compiled potentiality clients profiles and entered information into operating system to the team sales.
  • Revised and Organized sales paperwork, presented proposals and finalized new medicare members contracts.
  • Worked alongside representatives to boost sales by enhancing product presentations and advertising.
  • Produced reports, letters, and proposals for sales plan development southern region.
  • Daily meeting with the entire sales team and managerial. Coordination and delivery of possible prospect clients (leads) for visit and orientation of the benefits of the medical plan.
  • Maintained and organize inventory of marketing products such as benefit brochures, folders, and other informational documents.
Expected in 05/2004 to to Bachelor of Applied Science | Liberal Studies Pontifical Catholic University of Puerto Rico, Ponce, PR GPA:
  • Phi Delta Gamma Fraternity
  • Student Society for Public Administration PCUPR
Expected in 05/2006 to to MBA | Human Resources Management University of Phoenix Puerto Rico, Guaynabo, P.R. , GPA:

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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


  • Bachelor of Applied Science
  • MBA

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