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value base care manager resume example with 10+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, San Francisco, CA 94105
:
Professional Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
  • Contract negotiations/Fee for service and Value-Base
  • 5+ years of provider relations and/or managing a team
  • Provider relationship management
  • Strategic planning
  • Highly motivated self-started, self-motivated with ability to multi-task
  • Written Communication
  • Problem-solving and Critical Thinking
  • Educational Presentations
  • HEDIS knowledge-Quality improvement competency
  • Proficient with Microsoft Office Suite, Salesforce, Google, SharePoint, Tableau
  • Report preparation
  • Complaint resolution
  • Medical terminology knowledge
  • 11+ years of experience in Practice Management, Customer Service and Healthcare
  • Electronic health records
  • Familiar with Federal HIPAA and CMS Compliance & Regulations
  • Process and Performance Improvement Experienced
  • Relationship building and retention
  • Team Building
  • Service recommendations
  • Call center operations
  • Multi-line phone talent
  • Benefits, Hiring, Project lead, Telephone
  • Billing, Team Building, Protocols, Phone
  • Bi, Team-building, Quality, Transcription
  • Call center, Leadership, Quality assurance, Web Portal
  • Clerical, Managing, Quality improvement, Workshops
  • CMS, Marketing, Relationship building, Written
  • Coaching, Medical terminology, Relationship management, Written Communication
  • Continuous improvement, Meetings, Reporting
  • Contracts, Microsoft Excel, Research
  • Contract negotiations, Microsoft Office Suite, Risk management
  • Counseling, Office, Safety
  • Critical Thinking, Network, Scheduling
  • Customer Service, Organizational, Self-motivated
  • Direction, Personnel, Spreadsheets
  • Email, Policies, Statistics
  • Financial, Presentations, Strategic planning
  • Financial management, Problem resolution, Supervisory
  • Functional, Problem-solving, Teamwork
Education
Rasmussen University Tampa, FL Expected in December 2022 Bachelor of Science : Healthcare Management - GPA :
Florida Technical College Kissimmee, FL Expected in February 2012 Diploma : Billing/Coding - GPA :
Work History
Decatur County Memorial Hospital - Value Base Care Manager
Greensburg, IN, 06/2021 - 01/2022
  • Successfully able to facilitate Provider Web Portal and virtual training for existing and new provider contracted with Aetna Health Plan using Evoke 360
  • Communicate with provider groups on benefits of Value Base Care and how to increase their Quality and Risk scores
  • Increased user engagement across all provider groups and improved clinical and financial outcomes
  • Led Value Based Care strategies to increase quality metrics for Medicaid or Medicare line of business
  • Educate providers on products enhancements and new releases
  • Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
  • Conducted research, gathered information from multiple sources and presented results
  • Led projects and analyzed data to identify opportunities for improvement
  • Participated in team-building activities to enhance working relationships
  • Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
  • Created spreadsheets using Microsoft Excel for daily, weekly, and monthly reporting
OPTUM, UNITED HEALTH GROUP/WELLMED MEDICAL - Sr. Physician Business Manager
City, STATE, 12/2015 - 06/2021
  • Collaborate with healthcare providers to help them achieve high performance with their contracts
  • Confidently manage overall operation of patient care, or conditions, that might hinder patient's well-being including financial management, quality assurance, patient care, safety risk management, team satisfaction, quality scores, high utilization, and facility maintenance
  • Maintain communication between department heads, and medical staff by attending bi-weekly and quarterly financial meetings
  • Work with marketing, network, member retention, operations, and related operational areas to identify improvement opportunities focused on improving financial outcomes and member and provider engagement and satisfaction
  • Assist in credential audits and on-site provider assessments for Well Med Management
  • Identify and remediate claims to ensure early resolution of claim problems
  • Provider education of incentive programs and facilitation of member Healthcare records
  • Created spreadsheets to track monthly statistics of workshops and provider feedback for reporting purposes
  • Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions, and common goals
  • Answered provider inquiries via email, telephone, and written correspondence
  • Chaired weekly meetings with executive leadership to identify opportunities for improvement, establish milestones and tailor to individual markets
  • Onboarded and trained new staff to keep team efficient and prepare team members to effectively handle demands of simultaneous and large-scale contracts
  • Decreased utilization cost by 20% by implementing cost-saving initiatives that addressed long-standing problems
  • Created spreadsheets using Microsoft Excel for daily, weekly, and monthly reporting
IGNACIO SALZMAN - Practice Manager
City, STATE, 02/2011 - 12/2015
  • Managed staff of 5 personnel by implementing company policies, protocols, work rules and disciplinary action
  • Executed planning, implementation, and direction day-to-day operations for clinical, clerical, and billing staff
  • Acted as liaison between physician and staff to ensure achievement of mutual goals
  • Project lead: ICD10 implementation, EMR transition, office remodel, transcription software, and online scheduling
  • HEDIS training with doctors and medical staff
  • Maintain and oversee employee continuing education program
  • Evaluate employee performance quarterly and recommended merit increases
  • Responsible for hiring, training, coaching, and counseling
  • Established staff schedules and assignments based on office needs
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, efficient supervisory practices and facilitating proactive work environment.
Accomplishments
  • Used Microsoft Excel to develop tracking spreadsheets
  • Achieved 4.5 HEDIS Star Score Rating from a 1.5 through effectively helping with getting members seen and closing quality gaps
  • Trained provider and staff out of paper charts into new EMR System
  • Bravo Awards for building relationships and meeting 85% goal for HCC and Members Seen
  • Organized a successful event for October Breast Cancer
  • ANGUAGES
  • Nglish
  • Ative
  • Panish
  • Ilingual
  • Nowledgeable and dedicated Provider Relations professional with extensive experience in the healthcare industry
  • Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients
  • Motivated to maintain customer satisfaction and contribute to company success
  • Specialize in quality, speed, and process optimization
  • Articulate, energetic, and results-oriented with exemplary passion for developing relationships, cultivating partnerships, and growing businesses.

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Resume Overview

School Attended

  • Rasmussen University
  • Florida Technical College

Job Titles Held:

  • Value Base Care Manager
  • Sr. Physician Business Manager
  • Practice Manager

Degrees

  • Bachelor of Science
  • Diploma

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