Provider Contract Specialist Resume Cincinnati, OH - Hire IT People

SUMMARY:

A subject matter expert (SME) with a history of success in healthcare policy and business development.
Possesses analytic decision - making skills with an emphasis on process improvements and establishing quantifiable results in client account management.
More than 15 years of comprehensive experience in the healthcare industry and extensive knowledge in health law, policy administration, HIPAA, and CMS regulations.
Recognized for the ability to liaise with clients/affiliates that result in successful project outcomes.
A superior communicator with strong organizational and interpersonal skills.

TECHNICAL SKILLS:

PROFESSIONAL EXPERIENCE:

Confidential, Cincinnati, OH

Provider Contract Specialist

Responsibilities:

Charged with supporting Confidential ’s providers and communicating with Confidential ’s clients to foster greater physician understanding and cooperation during the contracting process. Verify that provider contracts properly address expectations leveraging standardized tools and quality processes. Serve as a liaison for Contracting and Service (DCAV, PPG, Credentialing, Service Fund); administer contracts; oversee data integrity, maintenance (including annual escalators), and any contract clarifications.
Maintain contracts, make changes/updates, and process network adds/deletes. Ensure initial credentialing; contact unresponsive providers through re-credentialing, and proofing directories. Quickly address and resolve discrepancies. Audit individual provider rosters and contract loads.

Confidential, San Antonio, TX

Healthcare Consultant

Responsibilities:

Successfully completed the enrollment of 300+ consumers into qualified health plans during annual open enrollment for the Affordable Care Act.
Educated consumers on affordability programs, government tax subsidies, Qualified Health Plans, Essential Health Benefits, and legal rights. Led customers through consultations on multiple services and options for healthcare coverage.

Confidential, San Antonio, TX

Medicare Caseworker

Responsibilities:

Built and managed a pipeline of Medicare cases consisting of improper payments to third-party administrators to assist in the collection of over-payment funds made by Medicare estimated at $12.5B+.
Used the demand process to finalize 18K+ correspondence items to ensure timely response aligned with Service Level Agreements.

Confidential, Atlanta, GA

Employee Benefits Specialist

Responsibilities:

Guided, consulted with, and assisted managers, supervisors and employees on coverage, benefit suspensions, dual coverage, loss of coverage, and plan changes aligned with the Affordable Care Act.
Directed activities related to the employee benefits program including managing open seasons for employee benefits, health and life insurance enrollments/changes, and providing guidance/counseling.
Counseled employees regarding corporation benefits programs to include health, life, vision, and dental insurance; savings plans; survivor benefits; flexible spending accounts; and other programs.

Confidential, San Antonio, TX

Employee Benefits Specialist

Responsibilities:

Sold/marketed health care and medical benefits to small-/medium-sized employer groups through affinity relationships.
Assisted clients with benefits/resources including presenting group health plans package that met their needs. Consulted clients/carriers to prepare competitive and appropriate benefits programs.

Confidential , San Antonio, TX

Sales Agent

Responsibilities:

Marketed and sold health insurance policies for pets to prospective clients on inbound and outbound calls Provided ongoing servicing to existing customers and maintained high levels of client retention.
Performed strict pre-sale underwriting of policies.

Confidential, Washington, DC

Data Quality Assurance Tech

Responsibilities:

Performed quality assurance reviews on over 300,000 incoming pathology cases for coding at the Walter Reed Armed Forces Medical Center aligned with the A.F. Institute of Pathology.
Reviewed pathology case folders and internal patient record contents regarding topography, morphology, etiology and function of disease including ICD-9, CPT, SNOMED codes.
Instrumental in the successful clinical follow-up on 3 major cancer research studies and monitoring timelines on the release of results.