Customer Service

Summary

Technically sophisticated and highly-skilled professional with expertise in Contracting, Recruiting, Provider Relations supplemented by vast experience in sells. medical billing and claims. Consistent success in establishing collaborative business relationships with physicians and other healthcare providers, with experience credentialing both physicians and facilities. Excellent communication and negotiation skills; communicates effectively with stakeholders at all levels of the organization. Not afraid to tackle tough projects, and consistently achieves self-goals of increasing knowledge. Uncompromising integrity and work ethic.

Skills

Contract Negotiation,Analytical Skills, Recruitment, Claims Education

Ouachita Baptist University Arkadelphia, Arkansas Bachelors of Arts 05/1985

Dean's List, National Dean's List, Who's Who Among American University and College Students, Ouachita Student Foundation, Vice President of the Student Senate, Homecoming Princess. Debate Team Experience

Centene Corporation Dallas, TX

Contract Negotiator 02/2017 - Present

Recruit and develop provider network plan for region and set of providers

• Identify and initiate contact with potential providers

• Negotiate contracts

• Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate the State’s reimbursement to the provider

• Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication

• Evaluate and monitor providers’ performance standards and financial performance of contracts.

• Assist with and track credentialing activities

• Facilitate the organization of provider focus groups

• Coordinate with internal departments and contracted providers to implement and maintain contract complianceRecruit and develop provider network plan for region and set of providers • Identify and initiate contact with potential providers • Negotiate contracts • Leads assigned negotiations (i.e., hospital, physician and ancillary) and ensure that negotiations result in the unit cost targets expected and meet the objectives of the company and approximate the State’s reimbursement to the provider • Facilitate and provide oversight to the provider set-up and contract configuration to ensure accurate claims adjudication • Evaluate and monitor providers’ performance standards and financial performance of contracts. • Assist with and track credentialing activities • Facilitate the organization of provider focus groups • Coordinate with internal departments and contracted providers to implement and maintain contract compliance. Copeland Insurance Group Plano, TX

Captive Insurance Broker 08/2016

Contracted and Licensed to sell Medicare, Healthcare Reform, Dental, Life for several different insurance companies in various States.

Optum Richardson, TX

Licensed Agent 08/2013

Responsible for servicing existing customers who call in concerning insurance plans. Responsible for retaining customers by recommending the best plans that will fit their needs. Responsible for selling new plans and ancillary products for individuals under 65. Health care Reform Certifications for Individual and Life plans. Sells agent also for Medicare Advantage, Prescription Drug stand alone plans, Medigap plans for individuals 65 and over. Group Insurance. Certified to sell insurance in 5 additional states. CMS Certifications. Experience with Inbound and Outbound sells. TTY/TDD experience for the Speech and Hearing Impaired. Winner of the MVP Award for Outstanding Employee. Winner of Highest Quality Award Tina Beed-Adams

972-***-**** ********@*****.*** Mesquite, Texas

Insurance Overload Dallas, TX

Claims Customer Service Contractor 06/2011

Handled claims and customer service for Long Term, Short Term disability claims and Life Claims for Dearborn National through client. Responsible for managing a block of standard disability claims, review and records on computerized database, resolve problems, refer to responsible parties and perform due diligence on customer inquiries through oral communication. Trained on Claims and Customer service systems and Star system for Life Claims. Universal American Dallas, Texas

Provider Relations Representative 08/2008

As a front-line representative for the company, maintained and enhanced existing provider relationships by leveraging health plan knowledge to address and resolve a variety of provider inquiries and issues. Worked closely with the Sales Team to pursue and establish strategic partnerships with a wide variety of healthcare providers to recruit them to the plan. Utilized policy, procedure, and professional experience to effectively respond to questions regarding contracting, fee schedules, claims payments, co-pay structures, and plan types. Collaborated across departments to quickly address action items and implement provider education and communication tools. Maintain provider accounts to ensure accurate data regarding billing information and practice locations.

Key highlights

Appointed as Contract Negotiator.

Expanded the firm’s client base by identifying, pursuing, and recruiting a wide variety of healthcare providers to the plan. Composed letters of agreement (LOA) for physicians and facilities. United Healthcare Insurance Plano, TX

Onsite Benefit Coordinator 01/2006

Rapid resolutions expert

onsite benefit coordinator

Quickly promoted to utilize extensive industry expertise in effectively resolving escalated problem calls from internal and external clients. As part of the Sales Team I worked as the Onsite Benefit Coordinator and managed all PPO/EPO accounts for the City of Dallas employee group. Handled claims resolutions and projects, Benefits liaison and performed onsite benefits presentations.

University of Texas Southwest Medical Center Dallas, TX Senior Claims Analyst 05/1998

Responsible for customer inquiries regarding claims processing issues, processed and adjusted claims for the department. IDX and Inbound Customer service experience. Strong oral and written communication skills, researched and collected insurance claims from companies, government agencies and other third party carriers. Blue Cross & Blue Shield of Texas Dallas, TX

Customer Service, Senior Claims Analyst 07/1990

FEP Federal Employee Program

Received claims related telephone inquiries form members and providers. Analyzed problems, explained payment procedures, processed claims, maintained records of all calls and status of inquiries, dealt with callers in a courteous and professional manner. Explained plan benefits, worked with assigned employer groups. IDX and Inbound Customer service experience

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