William J. Rodriguez Rivera

**** ********* ***, *** ***, St Cloud FL 34769 / 562-***-**** / ad0zoj@r.postjobfree.com

Authorized to work in the US for any employer

Work Experience

Provider Contract Specialist

Molina Healthcare – Long Beach, CA

Jan 2018 – Jun 2022

•Configure, test and update Health Plan provider contract and amendment templates in Conga CLM

•Work in partnership with assigned Health Plans/Business Teams to identify and load all fully executed provider agreements into the Conga CLM contract repository

•Collaborate with assigned Health Plan/Business Team Leaders on the development and testing of a Contract Process Workflow

•Prepare and route standard contract repository compliance and system performance reports to Health Plan and Business Team Leadership

•Create content and perform voice-over for educational videos and courses

•Travel as needed throughout designated region to facilitate end-user hands-on training and meet other targeted needs

•Configure and manage Health Plan-specific clause language library within Conga’s Playbook

•Partner with MIT Salesforce Team & ECSS Data Analyst to upload prepared bulk data into contract repository or Account Object

•Audit Conga CLM contract repository for accuracy and use

•Train users on the Conga Contract Lifecycle Management software

Assoc Specialist, Provider Data Management

Molina Healthcare – San Juan, PR

Jan 2017 – Jan 2018

•Prepare detailed analysis to resolving issues related to billing services and be effective in maintain a strong relationship with the client and/or the provider.

•Analyze, review, and load documents to support department operations.

•Maintains reconciliation and production reports for department.

•Prepares reports and analysis as needed.

•Experience with Excel

•Supports ad hoc reporting requests for department staff as needed.

•Identifies any inadequacies within the existing process, strategizes and designs improvements where possible.

•Performs other duties as assigned by department leadership.

Provider Relations Representative

Molina healthcare – San Juan, PR

Jan 2015 – Jan 2017

•Responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations.

•Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network.

•Responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Customer Service Representative

Xerox Corp – San Juan, PR

Jan 2014 – Feb 2015

Responsible for providing guidance and assistance to customers of the Electronic Benefits Transfer (EBT) for the Food Stamps, Medicaid and TANF programs of Alabama and Virginia states by telephone.

Responsible for providing guidance and assistance to customers of the Electronic Payment Card (EPC) for the Child Support, Unemployment Insurance and Home Care programs of Alabama, Massachusetts, Illinois and Utah states by telephone.

Responsible for verification, validation and guidance on the availability and use of your benefits for Medicaid transportation by phone.

Responsible for creating processes for the assistance in the training for new hires.

Responsible in the process of supervise and manage the time schedule for break and lunch of 30 employees including the shifting in the morning (Clock IN) and shifting in the afternoon (Clock OUT).

Responsible for preparing reports on Excel (Pivot Table) of total calls averages receive daily, weekly and monthly and ACW time and avoidance of all types of call manages in Call Center.

Provide assistance in the training process for new hires with handbook and bring professional support in floor during working schedule time.

Provider Network Representative

MMM Holdings, Inc – San Juan, PR

Apr 2012 – Dec 2013

•Responsible for providing guidance and assistance to providers, physicians, facilities, and hospitals in the MMM/PMC network by telephone.

•Responsible for providing support through the analysis of invoices to suppliers of MSO of Puerto Rico (MMM/PMC).

•Responsible for verification, validation and guidance on the availability and use of medical services to the network providers of MSO of Puerto Rico (MMM/PMC) by phone.

•Responsible for creating and generating processes that help to handle calls with network providers MSO of Puerto Rico and outside the network providers (U.S.).

•Responsible to provide support to other areas of the company such as the Claims Department by processing claims once laid low the regular adjustment process.

•Responsible for preparing and updating training manuals for new call center representatives.

•Facing the payment process and adjust for the professional and facilities claims.

Provider Customer Representative

Medical Card System – San Juan, PR

Dec 2010 – Mar 2012

•Responsible for providing guidance and assistance to providers, physicians, facilities, and hospitals in the MCS network by telephone.

•Responsible for providing support through the analysis of invoices to suppliers of MCS network.

•Responsible for verification, validation and guidance on the availability and use of medical services to the providers network of MCS by telephone.

•Responsible for creating and generating processes that help to handle calls with provider network of MCS and outside the providers network (U.S.).

•Responsible to guide and allow vision services and audiology services to providers of MCS network by telephone.

•Responsible for providing guidance and assistance to members and dependents of the business lines of MCS Classic Care Advantage and MCS Life Insurance Inc., by telephone.

Billing Analyst

Open Mobile – Guaynabo, PR

Jun 2007 – Oct 2010

•Responsible for executing and analyzing the monthly billing process of active customers in the allocated cycles.

•Generate monthly invoice files to be sent by FTP to the mailing company.

•Address matters regarding billings, payments, or other complaints. Verify accounts discrepancies, reconstruct billing statement, and apply adjustments when applicable.

•Generate month-end billing reports and provide that information to internal customers.

•Create and validate the system configuration of the new tariff plans and value-added services for new products to be marketed.

•Provided support/assistance in the preparation of billing system manuals, collaborate in the training of new personnel and special projects.

•Supporting customer service/retention areas by attending, investigating, and resolving client’s claims that enter via mail, telephone, or personal customer visit.

•Address matters regarding billings, payments, or other complaints. Verify accounts discrepancies, reconstruct billing statement, and apply adjustments when applicable.

•Notify client of action taken and promote retention.

Data Entry Clerk / Customer Service Rep

MoviStar – Guaynabo, PR

Sep 1999 – Jun 2007

•Provided support to Sales Representatives in equipment problems and assisted in credit verifications utilizing Equifax and Trans Union of Puerto Rico Credit Services.

•Engaged in process activations, changes, and contract cancellations; verified accounts, documentation, client information, credit cards and checks.

•Assisted Supervisor training new employees.

Member Service Representative

United HealthCare Plans of PR – Guaynabo, PR

Jul 1996 – Sep 1999

•Provided customer service in person or via telephone assisting in the verification of claims status and premium payments and followed up on services rendered with providers.

•Trained new personnel on Puerto Rico Health Reform procedures, analyzed claims for government, private and commercial accounts.

•Assigned from January to October 1999 to the University of Puerto Rico Central Administration Office to co-manage the enrollment of 10k UPR group.

•Processed authorization for medical studies, certified student’s coverage, reimbursed services, contracted providers and served as Acting Supervisor when needed.

Education

University Of Phoenix - Guaynabo, PR

Associate Degree in Business Administration

Aug 2005 – May 2006

Colegio Universitario Del Este - Carolina, PR

Associate Degree in Business Administration

Aug 1997 – May 1998

Interamerican University of Puerto Rico – San Juan, PR

Associate Degree in Business Administration and Computer Science

Aug 1993 – May 1996

Skills

Customer Service (26 years) Excel (14 years)

Organizational skills (26 years) Medicare Terminology (14 years)

Data Entry (26 years) Report Analysis (14 years)

Medical Terminology (14 years) Provider Networking Operations (8 years)

QNXT Configuration (14 years) URAC, NCQA, CMS and Medicaid Audits (8 years)

Credentialing (5 years) Claims processing (8 years)

Computer Skills

Languages

•English and Spanish (Oral and Written)

Software

•MS Word, MS Excel, MS Power Point, MS Outlook, WinSQL, Oracle, Mail Star, MHS, QNXT, MS Access

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