Customer Service Relations Manager

Lesley Fitzgerald

******.******@*****.*** 772-***-**** Chattanooga, TN 37416

Summary

Results-driven Provider Relations Manager known for high productivity and efficient task completion. Skilled in network development and provider education, ensuring streamlined operations within healthcare settings. Excel in communication, problem-solving, and relationship building, key soft skills that enhance performance and foster positive outcomes with providers.

Skills

•Provider relationship management

•Customer Service

•Process Improvement

•Problem-Solving

•Idea Development and Brainstorming

•Communication Skills

•Multitasking

•Positive Attitude

•Adaptability

•Problem Resolution

•Relationship Building

•Proficient in Facets, Sales Force, Power Point, Excel etc.

Education

University of Florida, Gainesville, FL

Graduated 12/2005

Bachelor of Arts in Elementary Education

Experience

United Healthcare

Manager, Provider Engagement Experience TN

11/2018 – 5/2025

United Healthcare

Provider Advocate

06/2011 – 11/2018

•Managed a team of 9 provider advocates across the state of TN.

•Developed and implemented strategies to improve provider relationships by increasing communication with providers.

•Built and maintained positive relationships with TMA, THA and MGMA.

•Provider Engagement Experience liaison with internal TN Health Plan to address urgent requests and provider outreaches.

•Developed and maintained positive relationships with providers to ensure compliance with contractual agreements.

•Working internally on claim denials to remove barriers for providers.

•Assisted in developing strategies to improve provider satisfaction levels.

•Researched provider inquiries and responded timely in a professional manner.

•Provided guidance and training to provider staff on best practices related to resolution techniques.

•Participated in and ran meetings with external and internal parties.

•Help with educational materials regarding program policies for providers.

•Remained calm and professional in stressful circumstances and effectively diffused tense situations.

•Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.

•Asist in developing training education for providers with a large focus on the provider portal and digital solutions.

•Navigating difficult situations and challenges between departments to find equitable solutions.

Arbor Healthcare, Franklin, TN

Provider Services Analyst, CPAT

02/2008 – 06/2011

•Recruited by Arbor to launch company’s operations in Massachusetts and establish provider relationships in multiple states.

•Provide hands on field training to new hires in conjunction with training department and management team to maintain continuity within the department.

•Field audit of hospital billing records resulting in refunds or additional payables for large health insurers.

•Identify, validate, and calculate incorrect reimbursement. Track trends and report inconsistencies to clients for correction to host systems.

•Advance knowledge of many healthcare billing systems, i.e. IBAX, Siemens and Meditech.

•Expert understanding of insurance rules and regulations regarding commercial, auto, workers compensation, personal liability, Champus, Medicare, & Medicaid claims.

•Advanced knowledge of the operation of health care financing and health care service contracts and agreements.

•Frequent travel is required

AvMed Health Plan, Tampa, FL

Physician Services Representative

7/2007 – 2/2008

•Orientated physicians and office managers to AvMed’s policies, procedures, and best practices for patients care.

•Provided follow-up office visits to enhance AvMed’s relationship with providers and assist with any outstanding questions or requests.

•Responsible for field investigations and resolution between AvMed, physicians, and patients.

•Provided contract support for the assigned territory, including expanding existing groups and recruiting new physicians.

•Traveled extensively to grow business, improve existing corporate relations, and resolve claim or plan conflicts.

AvMed Health Plan, Gainesville, FL

Credentialing Department – File Clerk

11/2001 – 12/2006

•Maintained multiple high volume filing systems.

•High data entry on departmental projects.

•Clerical support for department including fax, copy, and scanning of provider documents.

•Contacted providers to obtain necessary information to complete the credentialing process.

Pinewood Elementary School, Stuart, FL

3rd Grade Teacher

08/2006 – 05/2007

•Daily planning and instruction of students.

•Provided regular feedback to students and families with regards to development and progress.

•Created extracurricular programs on a weekly basis.

•Utilized behavioral management skills to resolve issues concerning intellect and emotion.

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