Katrina Tillman

** ******* ***** ** ******, DE **702

718-***-**** adx8gv@r.postjobfree.com

Qualifications Summary:

Excellent communication skills

Ability to implement defined service techniques

Excels in analyzing claim data

Reliable worker with the ability to learn new concepts and skills quickly

Solid work history, reputation as a team player, and a passion for helping others

Professional Experience:

AmeriHealth Caritas Newark, DE 11/17 – Present

Account Executive II

Identifies contracts and actively solicits qualified providers to participate in Plan network in new and existing service areas

Negotiates Physician and other ancillary contracts. Work with all levels of providers and types of provider systems

Communicates and follows up with prospective providers as assigned, until such provider submits application for plan participation

Submits accurate and complete provider application packages to Credentialing Department assuring timely credentialing.

Documents issues impacting recruiting efforts.

Remains current in all aspects of the RFP or Application requirements.

Maintains accurate concise records of all provider contacts.

Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.

Support collaborative team efforts that produce effective working relationships and trust.

Regularly suggests innovative means of structuring operations in a fashion that helps alleviate backlogs and ensures the optimal utilization of resources

Gateway Health Plan® Pittsburgh, PA 03/17 – 11/17

Provider Contracting Analyst

Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner

Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments

Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement

Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines

Aetna Better Health (A Division of AETNA) Philadelphia, PA 01/15 – 03/17

Network Consultant

Create and manage cooperative working relationships with providers and/or through personal visits, correspondence and telephone contact

Implement network development and refinement strategies

Conduct and manages ongoing audit of providers information

Provide issue resolution and complex trouble shooting for providers

Monitor multi-year contract rate changes, determine rate adjustments and ensure rate entry into provider/contract systems

Coordinate the filing of base contract documents within each state in the region

Work with management to draft, clarify and recommend changes to policies which impact network management

Delaware Physicians Care (A Division of AETNA), Newark, DE 02/12 - 01/15

Case Management Associate / Long Term Service Support

Made outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.

Assisted in the research and resolution of claims payment issues

Promoted communication to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively)

Maintained accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements

Screened members using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan

Performed non-medical research including eligibility verification, COB, and benefits verification

Investigated and responds to member inquiries regarding benefit

Documented complaints and grievances from members and refer them to the appropriate department for timely resolution

Assisted members in the Money Follows the Person program (e.g., assist members with housing transition from a skilled facility back into community, retrieving documents, etc.)

Delaware Physicians Care (A Division of AETNA), Newark, DE 05/10 - 02/12

Inbound Queue Associate / Prior Authorizations Representative

Performed intake of calls from providers regarding services via telephone, fax, EDI.

Approved services that do not require a medical review in accordance with the benefit plan

Performed non-medical research including eligibility verification, COB, and benefits verification

Protected the confidentiality of member information and adheres to company policies regarding confidentiality

Screened request for appropriate referral to medical services staff

Promoted communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as members, family, and health care team members respectively

Placed outbound calls to providers under the direction of medical management to obtain clinical information for approval of medical authorizations

Skills: Excellent Organizational Skills, Computer Proficiency, Data Entry, Excellent Written and Verbal Communication Skills, Exceptional Telephone Etiquette, Ability to respond to changing circumstances and priorities in a focused manner, Working knowledge of medical terminology, ICD-9 and CPT Codes

Computer Skills

Word

Excel

PowerPoint

Outlook

QNXT

Rumba

Quick base

SQL

Smart Front End

REFERENCES AVAILABLE UPON REQUEST

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