Customer Service, Provider Relations
Resume:
Dione D. Major
Gibsonton, FL ***** 813-***-**** **********@*****.***
Links
https://www.linkedin.com/in/dionemajor
Summary
Over 10 years of experience working in the Managed Healthcare industry. An organized and dependable candidate successful at managing multiple priorities with a positive attitude. Expertise in relationship building, remote work experience, account management, customer service, provider relations, claims, and contracting.
Skills
Customer Relations Management
Empathy and Emotional Intelligence
Problem Solving Skills
Multitasking and Time Management
Adaptability and Resilience
Product and Process Knowledge
Teamwork and Collaboration
Technical Skills
Patience and Professionalism
Continuous Learning
Experienced in Microsoft Office, Microsoft Teams, Sales Force, Availity, QNXT, Kronos
Work History
Realtor Associate, 09/2019 - Current
Redfin – Tampa, FL
Liaised between buyers and sellers to provide positive experiences for both parties.
Assisted buyers with finding ideal homes by assessing needs and requirements.
Prepared homes for client arrivals during open house events and established signage and provided feedback to sellers on potential buyers
Provider Contracting Professional 2, 10/2018 - 11/2020
Humana – Tampa, FL
Managed key relationships with multiple physician/provider groups which resulted in over 80% in accurate claims reimbursement.
Negotiated rates and implemented contracts and amendments for Primary Care Physicians and Specialists.
Executed Medicaid, Medicare, and Commercial Lines of Business Contracts.
Collaborated with Legal and Finance team in negotiating reimbursements on contracts that resulted in significant financial savings.
Provider Services Representative II, 10/2015 - 10/2018
Molina Healthcare – Tampa, Florida
Provided service and education to network physicians and provider groups.
Implemented on-site training for newly enrolled providers and as-needed refresher training for providers.
Accommodated providers with enrollment and credentialing process.
Assisted providers with resolving claims processing/payment issues and Hedis scores which resulted in the overall quality of care for patients and reimbursement for the health plan.
Provider Resolutions Coordinator, 10/2014 - 10/2015
Integral Quality Care – Tampa, Florida
Worked Appeals/Grievance requests that came in from Florida Agency for Healthcare Administration (AHCA) and Provider Relations department.
Established over 80% reimbursement accuracy of claims payments.
Performed as liaison between providers and the health plan.
Claims Specialist, 10/2013 - 10/2014
Freedom Health Inc – Tampa, Florida
Processed Medicaid Claims from physician/provider groups.
Researched Appeals correspondence received from medical partners
Reviewed and resolved over 100 Appeals to ensure appropriate payment adjustments/reimbursement which resulted in over 90% accurate compensation on affected claims.
Education
Associate of Arts: 08/2015
Saint Leo University - Tampa, FL
Diploma: 1990
Thomas County Central High School - Thomasville, GA
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