Provider Relations Specialist

Trina Boyles (Hall)

*************@*****.*** Cell 310-***-****

**** *. ******** *** *** 3, Inglewood CA 90303

PROFESSIONAL EXPERIENCE

Expanding access to affordable, high quality health care starts here. Responsible for a full range of provider relations, provider contracting and service interactions. I have 7 years of experience in Provider Contracting, Business Development, Provider Relations, HEDSIS and Medical billing. My goal is to obtain a full time job with benefits in the healthcare industry. I strongly feel my skills and knowledge will be a great asset to your company.

PROFESSIONAL DEVELOPMENT

Computer skills include MS Outlook, Excel, Assess, Share Point and Power Point. My knowledge includes various healthcare systems QNXT, IDX, Flexcare, EPIC, FACETS, Web Track, SSI and Artiva. I am currently an active member of Medicare Advantage Healthcare Colleagues, Healthcare Reform Group.

Previous roles included business/network development, provider contracting, provider relations, auditing physician operating, healthcare report analysis and teaching Medical Billing and Coding at Anthem College.

Proficient in ICD-9 and 10, CPT and HCPCS codes, billing, collection, and Coding while conducting ongoing provider education.

Strong knowledge in Managed care, HMO, PPO, Worker Compensation, Medicare, IPA, MediCal and TRICARE

Able to negotiate and put into place letters of agreement with providers that are needed on an urgent and one-time-only basis

Great knowledge HEDIS and HIPPA

Provider Relations Specialist (temp) Cypress, CA

Beacon Health Option 05/2015-Present

Creates and manages training curriculum related to subject matter including provider relations staff trainings, provider orientations and ongoing provider support.

Plan and facilitate trainings using various technology solutions, including new applications and procedures.

Maintain a collaborative relationship with the operations, business personnel and provider community to incorporate process-related information into the training curriculum

Answering provider questions about Beacon Health Options, its contracts, policies and procedures

Provider Relations /Molina Healthcare (temp) Long Beach, CA

Member Services Rep 12/2014-Present

Educate provider on MediCal/ Medicare

Answer inbound and outbound call

Report issues and concerns to management

Benefit Clarification

Work with co-worker, management and other departments to coordinate problem solving in an effective and timely manner.

Responsible for handling and resolving complex member/ provider issues.

New Provider Orientation

Glenridge Healthcare Solutions Columbia, MD

Professional Healthcare Consultant (remote) 01/2014- 5/2014

Negotiate Contracts for providers, hospital, large medical, ancillary and DME

Network Development in rural and gap fill areas

Research providers to recruit for clients

Identify trends in healthcare markets

Prepare contracts and amendments due to document language changes

Anthem College (part-time) Sacramento, CA

Instructor / Medical Billing &Coding 09/2013-01/2014

Maintain a teaching assignment for each module.

Instruct the assigned course(s) in accordance with the approved curriculum.

Ensure that the quality and quantity of instruction provided in the classroom is consistent with the stated objectives of the school and industry.

Maintain a daily record of student attendance and grades in accordance with school policy.

Ensure that the classroom and school’s atmosphere is conductive well to maximum learning and retention of students.

Dignity Health (contract position) Rancho Cordova, CA

Healthcare Analyst / Medical Billing 04/2013- 7/2013

Process Secondary Billing for Medi-Cal / Medicare

Research claim, audit and system problems

Responsible for collections/ posting to patients accounts

Run and work confirmation/ rejection report

Update provider files to insure proper payment and provider demographic

Report trend to upper management

Sutter Physician Services (contract position) Sacramento, CA

Worker Compensation/ HMO Analyst 02/2013-04/2013

Follow – up on Account Receivable, Worker Comp, Medical, Medicare, HMO

Communicate with Employer, worker compensation carrier and Health Plans

Identify trends in healthcare industry

Collections

Update provider files in database

TNT Medical Billing, Claims and Consultant Sacramento, CA

Business Development Manager 03/2010- 03/2012

Negotiate and renegotiate contracts for hospital, providers and large medical groups.

Review Policies and Procedures to assure that all new and corrected claims are processed correct.

Consult providers on the business opportunity and update medical software

Acted as a liaison between companies, health plans, providers and work compensation clients to increase and maintain business

negotiate and put into place letters of agreement with providers that are needed on an urgent and one-time-only basis

BLUE SHIELD OF CALIFORNIA (contract) El Dorado Hills, CA Provider Contract Specialist 10/2009-02/2010

Create, negotiate, revise and maintain Business Associate Addenda (BAAs) for client

Select/develop appropriate contract and revise existing BAAs based on renegotiated provision.

Provide information as required for privacy-related BAA’s and contract issue or term

COVENTRY HEALTH PLAN, Sacramento, CA

Provider Contract Specialist 02/2005-06/2009

Responsible for research, negotiation and renegotiation

Acted as a liaison between the health plans and company to ensure ongoing communication

Responsible for development and monitoring provider contracts

negotiate and put into place letters of agreement with providers that are needed on an urgent and one-time-only basis

Negotiate national contract DME, home health, hospital, large medical group and Medicare

HEALTHNET FEDERAL SERVICES Rancho Cordova, CA

Senior Provider Relations Rep 10/2000-06/2004

Liaison between the company and network providers for TRICARE

Negotiated individual and medical group provider contracts

Conducted provider education workshop for physicians, hospital, ancillary providers

Resolved claim issue with internal and external clients

Assist in the training and development for new Providers

Instructor

Education

University of Phoenix BSBA

Contact this candidate