Product Specialist Customer Service
Resume:
Latina Clark
Email: *************@*****.***
Objective
I am an experienced network management professional with over 20 years in the Workers’ Comp Auto-No-Fault industry, seeking to leverage my extensive knowledge in contract negotiation, provider recruitment, and cost containment as a Network Product Specialist. I am adept at building and maintaining strong professional relationships, resolving escalated issues, and ensuring compliance with service specifications. I am proficient in utilizing financial models and analysis to achieve industry discounts and drive revenue growth. I am committed to delivering exceptional customer service and achieving organizational goals in a high-stress, goal-oriented environment.
WORK EXPERIENCE
Network Product Specialist
UHG/OptumRx, Workers’ Compensation and Auto No-Fault -Tampa, FL
September 2022 - Current
As a Network Product Specialist at UHG/OptumRx, Workers’ Compensation and Auto No-Fault, I maintain regular contact with key provider organizations within the Optum network to ensure adherence to Optum carrier clients’ service specifications. I resolve internal and external escalated issues concerning network providers and educate providers on new protocols, policies, and procedures relevant to their network participation. Additionally, I assist with provider recruitment by facilitating the distribution of provider agreements, negotiating service rates, obtaining credentialing documents, and performing business background screenings. I also ensure the accuracy and completeness of the provider database.
Customer Service Associate II
UHG/OptumRx, Workers’ Compensation and Auto No-Fault - Tampa, FL
December 2004 to September 2022
Redirect Billing Specialist: Provided cost containment to carrier clients by reviewing and repricing provider/vendor bills for ancillary services, achieving a minimum cost savings of 8% on all billed invoices. Secured new upfront vendor and provider referral business, generating additional revenue for Optum. Utilized knowledge of HCPCS/CPT codes, Medicare Allowable, State Fee Schedules, and Optum’s U&C Fee Schedule to determine repricing goals and cost-saving opportunities.
Referral Intake Specialist: Received and validated referrals from various sources, including Adjusters, Nurse Case Managers, Doctors, Vendors, and Claimants, to provide medical services and equipment to claimants. Assisted with assigning referral requests to the appropriate department for provisioning and fulfillment.
Patient Care Coordinator: Coordinated the delivery of medical services and equipment to claimants by utilizing Optum’s provider network. Located providers, confirmed authorization of services, obtained necessary medical documentation, provided purchase order agreements, communicated with patients, maintained patient files, and updated work comp carrier clients on the outcome and cost savings of services provided.
Order Completion Red Folder Specialist: Researched provider invoices with billing discrepancies, confirmed completion of services, ensured appropriate client authorization, and made necessary corrections to Optum’s Purchase Order Agreements to process provider/vendor invoices.
EDUCATION
Diploma
Hillsborough High School - Tampa, FL
May 1996
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