Contract Specialist Customer Service

TRELINDA SHORTER

Riverview, FL *****

813-***-**** advg17@r.postjobfree.com

Seasoned Provider Relations Professional experienced in Managing, building and nurturing Provider relationships through Networking and building exceptional rapport. Excellent Customer Service Specialist skilled in Retention, Appeals and Grievances. Over 20 Years of Customer Service, strong oral and written communication skills; ability to work as a team player; possess high levels of integrity; organizational skills; problem-solving and decision-making skills; ability to handle multiple tasks; ability to remain calm and to be patient when working with customers; ability to be honest and empathetic with customers and employees; and capable of conducting all business in an ethical and professional manner.

PROFESSIONAL EXPERIENCE:

United Health Group/LHI

Employed: 4/26/2019-Present Remote: Work from Home

Logistics Health Inc. Provider Network Contract Specialist

● As a Provider Network Contract Specialist I am responsible for Contracting, Fee Negotiations, Recruitment of Physicians and Facilities.

● Executed a self-directed approach to evaluate current Contracts for accuracy and determines geographical needs.

● Utilizes excellent Customer Service skills to ensure the needs of each Practitioner/Facility are met.

● Maintains contracts and documentation within a tracking system. Understands department and organizational strategy and operational objectives.

● Works independently making decisions regarding work priorities with minimal to no supervision.

Surgery Partners

Senior Managed Care Coordinator (2016-2019)

● Manage facility contracts to ensure rates, fee schedules, and agreements are in full compliance with organization guidelines

● Prepare onboarding packets to welcome Customers to the organization and provide copies of contract agreements.

● Communicate effectively with Customers to educate on usage of the provider portal and enter all contract information into the database.

● Worked closely with Credentialing and other departments verifying Practitioner’s accreditations and conducted regular Audits to ensure Practitioner were obeying Contract terms.

● Collaborated with various insurance carriers and healthcare organizations to successfully credential new providers to perform services in any specialty. Capable of maintaining multiple provider accounts and identifying insurance coverages.

● Utilized the following Tools: Authorizations CAQH Provider Portal Fee Negotiations Primary Source Verification Medicare/Medicaid Workers Compensation Strategic Planning/Analysis Contract Verification Accounting and Finance Business Development Provider Relations Insurance Verification

Florida Orthopedic Institute

Provider Relations Specialist (1997 - 2016)

Worked closely with marketing and practitioners to build a strong network with quality providers to perform service needed within the healthcare organization.

Oversee and processed credentialing and re-credentialing for all practitioners to ensure all accreditation are current with state guidelines.

Composed all negotiated fee agreements for non-par payer

Verified all contract agreements for accuracy prior to finalizing the credentialing process

Conducted monthly education session to keep staff updated on all new changes with insurance carriers.

Workers Compensation Team Lead (1997 – 2016)

Worked closely with providers, and practitioners creating NPI and CAQH profiles to utilize the portal.

Verified providers state licensure, and accreditations, to ensure their capable to perform certain procedures within the scope of specialty.

Created Medicare and Medicaid applications online for providers to join the network.

Responsible for developing and submitting reports to management account for the number of providers Credentialed monthly.

EDUCATION

High School Diploma,

Monroe High School, Rochester NY Stratford Business School, Rochester NY

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