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Supervisor Resume Example

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SUPERVISOR
Professional Summary
High performing provider network contracting and credentialing management with expertise in building/optimizing processes, payment measurement systems, and new and unique programs to maximize business results in managed Medi-Cal and health care systems. Skilled and experienced in developing new business strategies and managing the process to ensure high level performance. Extensive scope of responsibility with proven success in delivering results achieving measurable outcomes in the following areas: Contract Negotiations Cost reductions through unique payment models Attaining Revenue Growth Reduced production and increase in productivity gains
Education and Training
June 2011
University of PhoenixStateBachelor of Science: Healthcare AdministrationHealthcare Administration
June 2009
Sacramento City CollegeStateAssociates: Science and MathematicsScience and Mathematics
June 2003
Elk Grove High SchoolCity, StateHigh School Diploma
Skill Highlights
  • Contracting:
  • Medi-Cal
  • Medicare
  • Commercial
  • Unique Letters of Agreement and Memorandum of understanding
  • Operational process improvement
  • Negotiation, persuasion and communication for high level contracts
  • Performance Management
  • New product and program implementation
  • Training & Leadership Development
  • Quality Management and Improvement
  • Financial and Data analysis
  • Cross departmental team leadership
  • Business and Strategic Development
  • Project planning/Execution
  • Provider and Patient satisfaction
Skills
Auditing, benefits, billing, case management, contracts, Client, customer service, Data analysis, Financial, financial analysis and reports, insurance, team leadership, Leadership Development, Letters, office, Negotiation, networking, Performance Management, persuasion, policies, processes, process improvement, program implementation, Project planning, Quality Management and Improvement, researching, research, Strategic Development, training programs, treatment plans, troubleshooting, Unique
Professional Experience
07/2014 - Current
Company Name － City, StateSupervisor
11/2013 - 07/2014
Company Name － City, StateProvider Relations/Account Manager
  • Assist in development of physician visit policies and procedures to include visits, new provider's orientation, implementation of new policies and providing assistance to physicians' office staffs, as needed.
  • Document and file visitation records and report on a regular basis to Administrator & Executive Vice President.
  • Assists with the development and implementation of provider training programs.
  • Effectively integrate new programs and strategies per member per month targets, and provide oversight to the provider set up and contract configuration to ensure accurate claims processing.
  • Perform financial analysis and reports to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives.
  • Evaluate and monitor providers' performance standards and financial performance of contracts.
  • Analyzes changing business requirements; makes recommendations to management for process improvements as required.
01/2011 - 11/2013
City, State
  • Create and analyze reports based on set turn-around times to keep within compliance of both Medicare and Medicaid requirements Provide feedback and critical analysis for customer service department as well as Utilization Review department staff.
  • Create and analyze reports based on set turn-around times to keep within compliance of both Medicare and Medicaid requirements Provide feedback and critical analysis for customer service department as well as Utilization Review department staff.
  • Assist with data analytics and implementation of new developing utilization management programs National Client and Provider Relations, Landmark Healthcare.
05/2009 - 01/2011
  • Assist members and providers with claims submission, utilization review, eligibility and appeals for an array of health insurance plans Assisted with various implementation processes and projects Web Support and provider relations including networking and credentialing Responsible for escalated issues and complex billing problems that require analytical thinking and intensive research Worked closely with the Utilization Review staff including case management to ensure that policy and procedures are being followed appropriately Assist members and providers with the utilization and review process including authorizations, treatment plans, and medical record submission Resolving simple to complex provider inquiries, correcting errors, troubleshooting and researching issues related to member eligibility and benefits Analysis of claims processing Auditing of Claims.
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Resume Overview

School Attended

  • University of Phoenix
  • Sacramento City College
  • Elk Grove High School

Job Titles Held:

  • Supervisor
  • Provider Relations/Account Manager

Degrees

  • Bachelor of Science : Healthcare Administration
    Associates : Science and Mathematics
    High School Diploma

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