Project Management Contract Coordinator

Q’uiana Kelly

adzpbi@r.postjobfree.com 312-***-**** Chicago, IL

CUSTOMER SUPPORT PROFESSIONAL VETERAN

SUMMARY OF QUALIFICATIONS

Successful coordinating with operational and credentialing teams for contract and roster.

supporting network-related initiatives while comfortability working across multiple lines of business including both commercial and government products.

Delivering service that goes beyond organizational expectations.

PROFESSIONAL EXPERIENCE

Imagine360 Chicago, IL Aug 2021 – Aug 2022

Provider Operations Specialist

Assists with loading and testing of provider contracts across existing claims processing systems.

Support other operations resources in the setup of new contracts, fee schedules, contract amendments or provider demographic updates.

Coordinate with Provider Engagement to track and implement annual contract rate updates as needed.

Triage and handle any claims pricing inquiries related to contract programming and coordinate next steps across various departments for resolution.

Audit contract load completion and adherence to contract terms.

Review and coordinate with team members to ensure provider demographic data included with contracts aligns with the corresponding reimbursement agreements.

Centene Corporation Chicago, IL Jul 2021 – Aug 2021

Provider Contract Coordinator II

Evaluated all incoming and outgoing paperwork, including directory updates, provider credentialing applications, and contract maintenance forms, among others.

Conducted comprehensive audits of configuration loads on new and existing contracts in support of contract, office, project management, and data analysis.

Compiled and maintained credentialing and required documents for newly contracted providers for network management representatives to create contracts.

Blue Cross and Blue Shield Chicago, IL Jan 2021 – May 2021

Contract Administrator

Support network-related initiatives including executing simple contracts and rostering reviews.

Coordinate with operational and credentialing teams for contract and roster loading.

Navigate organizational systems and processes while interfacing with providers.

Effectively communicate with the contracting team to ensure timelines and priorities remain on track.

Aetna Better Health of Illinois Chicago, IL Sept 2019 – Jul 2020

Contract Coordinator

Collected, tracked, prepared, compiled, and distributed statistical data for daily and ad hoc reports.

Interfaced with credentialing staff to sync data and systems. Maintained spreadsheets and databases.

KINDRED NORTHLAND LTAC HOSPITAL Chicago, IL Jul 2019 – Sept 2019

Insurance Verification Specialist

Contacted Medicare, Medicaid, and private insurance companies to obtain benefit and eligibility information.

Obtained prior authorization for services being rendered.

Howard Brown Health Chicago, IL Apr 2019 – Jul 2019

Credentialing Specialist

Completed provider credentialing and re-credentialing applications.

Monitored application flow and controlled substance licenses.

Maintained copies of the current state, DEA certificates, malpractice coverage, and credentialing documents for all clinical providers.

Updated demographic information health plans, agencies, and other entities. Maintained appointment files in the credentialing database audited health plan directories for current and accurate provider information.

Northwestern Memorial Hospital Chicago, IL Jun 2018 – Dec 2018

Patient Accounting Specialist

Liaised with insurance and billing companies to communicate and resolve all inquiries and issues.

Maintained detailed charts and patient accounts.

Updated billing system database with correct information.

Reviewed coding and billing questions from patients while requesting rebills to facilitate streamlined payments.

Collaborated with health information management teams to obtain medical records for insurance appeals, release of information, chart evaluations, and present documentation to billing companies and legal counsel.

WellCare Health Plans Chicago, IL Oct 2017 – May 2018

Provider Contract Coordinator

Evaluated all incoming and outgoing paperwork, including directory updates, provider credentialing applications, and contract maintenance forms, among others.

Conducted comprehensive audits of configuration loads on new and existing contracts in support of contract, office, project management, and data analysis.

Compiled and maintained credentialing and required documents for newly contracted providers for network management representatives to create contracts.

Aetna, a CVS Health Company Chicago, IL Nov 2013 – Oct 2017

Referral Specialist

Utilized ICD, CPT/HCPCS coding and clinical information to research appeals for medical pre-certified services. Headed teams through day-to-day operations, ensuring adherence to resource allocation strategies and processing authorizations via large volume of phone calls .

Provided comprehensive training and development of new and existing employees.

Reviewed/processed denial letters and coordinated decisions with personnel.

Streamlined exchange of information through centralized databases.

EDUCATION

Ashford University Aug 2016 - Present

Bachelor of Applied Science - BASc, Health/Health Care Administration/Management

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