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Credentialing Supervisor

Location:
Houston, TX
Posted:
December 27, 2018

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Resume:

WAYNE COX, JR.

*** * *** ******* **** S, Houston, TX 77042

ac7194@r.postjobfree.com 615-***-****

SUMMARY OF QUALIFICATIONS

Workflow Management: Lead support for a variety of program participants and staff. Prioritize and organize workloads to meet strict deadlines, train and support team members. Establish and maintain strong working relationships with market directors, executives, management, and staff.

Technical Proficiencies: Microsoft office, Remote Support Tools such as LogMeIN and Skype Business, as well as data Tracking Programs such as CRM, CMS, RTA, and Etalk

Strengths and Accomplishments: Ability to achieve objectives within strict deadlines and resolve complex issues. An unwavering commitment to customer service. Strategic utilization in collaborating and networking. Hand selected to provide Team Lead support to Cigna's Provider Senior Analyst Support Unit. EXPERIENCE

CREDENTIALING SUPERVISOR PROVIDER RELATIONS LEAD SENIOR ANALYST II CIGNA HEALTHCARE • November 2015 – November 2018

Ensured high Level responsibility for provider networks and development strategies including physician recruitment, and Healthcare provider’s initial contracting/credentialing process.

Analyzed the effectiveness of existing business processes and developed, sustainable, quantifiable business process improvements.

Researched resolution for health care providers issues and trends identified by Healthcare professionals themselves as well as Cigna’s Vendors and Matrix Partners

Provides timely response and resolution to provider issues identified and reported in Cigna’s ART tool targeting and tracking database.

Responsible for Rate Negotiations for all Network Adequacy Provisions (NAP) and Single Case Rate Agreements (SCA) and (Prior Authorizations) before deadlines are met.

Assisted in the Interview processes of Cigna’s prospects and new hires for the provider relations and credentialing roles

Monitored quality and control of our inbound contact center for Credentialing and assisted in New Hire Training as support to offsite trainers

Lead Projects for the Provider Data Management unit, and Medical Onboarding team. SENIOR LIVING ADVISOR • BROOKDALE SENIOR LIVING

March 2015 – August 2015

Marketed campaigns that assist seniors in locating housing; via email, incoming calls, and live chats with prospects.

Advised on the correct senior living solution for my leads/customers, providing them with all necessary housing information

Financially qualified prospective residents to tour our communities nationwide and/or set up health assessments to have them enrolled as a new resident at a Brookdale Community. WAYNE COX, JR.

680 W Sam Houston Pkwy S, Houston, TX 77042

ac7194@r.postjobfree.com 615-***-****

CENTRAL OFFICE ASSOCIATE II • BROOKDALE SENIOR LIVING November 2014 – March 2015

Coding and billings specialist, payroll, reconciliation on accounts, proper filing of payroll and billing documentation including data entry

Prepared and completed weekly Timed Detailed Reports using Excel spreadsheets

Assisted with completing orientations for new employees.

Maintained positive relationships and rapport with residents, therapists and all community personnel; ensured the confidentiality of all patient information in compliance with all community and corporate policies

TECHNICAL SUPPORT REPRESENTATIVE AND QUALITY (SUPPORT LEAD), ASURION January 2013 – September 2014

Assisted with coaching, mentoring, and training customer service representatives. Implemented improvement opportunities for quality and training purposes and prepared feedback in a timely fashion.

Met and exceeded all customer satisfaction goals, quality standards, and resolution rates. Handled high volume of customer inquiries with the focus on problem solving and technical resolutions. Assisted with keeping customers updated on new promotions, software, and product benefits. EDUCATION

B.S. Degree in Business Administration: Concentration in Finance Graduated May 2013 - Alcorn State University



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