Healthcare Operations & Contract Management Leader

Margie Trent

Murfreesboro, TN 615-***-**** **********@*****.***

Professional Summary: Healthcare operations and contract management expert with 30+ years of experience in provider data analysis, credentialing, and network optimization. Proven ability to lead audit/projects, streamline processes, and ensure compliance across multiple markets. Skilled in managed care principles, claims administration, and cross-functional collaboration.

Core Competencies:

Provider Contract Management

Credentialing & Compliance

Data Analysis & Reporting

Claims Administration

Team Leadership & Training

Systems: Facets, Emptoris, UNET, COSMOS, CLM, CDM

Work Experience:

United Healthcare

Retrospective Contract Auditor November 2022 – January 2026

Responsibilities:

Validated contract and provider configurations.

Validated end-to-end processes/SOPs to ensure clear alignment.

Worked across multiple health plans to ensure consistency and compliance.

Collaborated with other business teams to ensure the provider’s configuration is done correctly.

Understanding of provider reimbursement and system architecture to drive cross functional team collaboration.

Interpreted and/or verify contract language, information, and intent in order to audit information in systems properly.

Assisted with audits and other quality controls for proactive identification of issues.

Build and maintain relationships with business partners to ensure desired results are attained and maintained.

Verified claims payment and pricing accuracy.

Served as a key resource to others on complex /critical issues.

Identified solutions to non-standard requests and problems.

Presented high-level findings, reports, and recommendations to Sr. Leadership and stakeholders.

Held stakeholders accountable for updates, root cause remediation, and prevention measures.

Analyzed trends and identify system issues to reduce provider abrasion.

Created and delivered training materials.

Assisted with peer audits and quality controls for proactive identification of issues.

Served as a subject Matter Expert (SME) for contract audit processes and system architecture during cross functional projects.

Provided coaching and constructive feedback, and guided team members towards achieving goals.

Network Program Consultant /Contract Management Expert March 2021 – November 2022

Responsibilities:

Managed all hospital/ancillary contracts supported by UHN, assigned for all lines of business.

Formed internal partnerships to improve communication, coordination, collaboration, and effective working relationships within own department.

Served as subject matter expert to Mississippi Market.

Assisted with Georgia, Louisiana, and Alabama Markets.

Performed audit on facilities.

Utilized and understanding relevant computer systems, applications and/or platforms (e.g., SharePoint; MS Word; COSMOS; UNET; CSP Facets) to perform work duties.

Managed the claim hold process to minimize claim rework.

Executed hospital contracts in Emptoris/PAL.

Met metrics and expectations set up by leadership.

Sr. Provider Data Analyst January 2017 – March 2021

Responsibilities:

Interpret customer needs and requirements.

Worked with minimal guidance, seeks guidance on only the most complex task.

Translated concepts into practice.

Provided explanations and information to others on difficult issues.

Coached, provide feedback, and guide others.

Assisted with new staff.

Maintained metrics.

Worked directly with 10 Markets.

Worked directly with PCDM with urgent issues.

Loaded contracts directly to NDB creating new MPINS for providers, making updates as needed for providers, and loading contracts.

Executed contracts in CLM.

Worked on special projects as needed.

Employer Installation Administrator – January 2015 – January 2017

Responsibilities:

Reviewed, interpreted, and loads Pricing and Claims Rules to support Community and State business.

Provided high level configuration analysis and approach to ensure load into CSP Facets is accurate based on approved Business Requirements.

Developed, analyzed, and monitor new, routine, and ad hoc reports using standard database tools.

Evaluated, interpreted and analyzed data, configuration options, and/or business processes.

Collected, analyze and document business requirements for cross functional projects.

Coordinated with configuration and other teams in cross functional project and achieve timely and accurate deliverables.

Worked with other departments to clarify project/contract intent.

Comprehended and applied industry payment methodologies to configuration and claims research.

Performed other duties as assigned by department management.

Provider Installation Administrator – July 2013 – January 2015

Responsibilities:

Audited Facility Contracts for TNCARE and Iowa Hawk-I in Facets

Audited Facility Contracts for Mississippi in ppoONE

Used pertinent data and facts to identify and solve a range of problems within area of expertise.

Investigated non-standard requests and problems, with some assistance from others.

Worked exclusively within a specific knowledge area.

Prioritized and organized work to meet deadlines.

Coached, provide feedback, and guide others.

Acted as a resource for others with less experience.

Reviewed facility contracts to ensure information submitted is accurate and consistent with loading guidelines.

Communicated identified discrepancies back to contract submitter to facilitate corrections of discrepancies.

Interpreted and/or verify contract language, information, and intent to load information into systems properly.

Performed audit on new and/or existing provider contracts and fee schedules to ensure accuracy.

Received and responded to escalated issues and problems involving contract submissions

Provided explanations and information to others on topics within area of expertise.

Assess and interpret customer needs and requirements.

Identified solutions to non-standard requests and problems.

Solved moderately complex problems and/or conduct moderately complex analyses.

Translated concepts into practice.

Provided explanations and information to others on difficult issues.

MME Support Manager – February 2013 – July 2013

Responsibilities:

Attended Medicare/Medicaid Meeting.

Conducted Preassessments for MI, OH, AZ, HI, and WA.

Conducted Annual Audits.

Network Account Manager – March 2010 – February 2013

Responsibilities:

Obtaining and monitoring provide information.

Maintained current provider data to ensure the quality of the network.

Conducted audits and provides feedback to reduce errors and improve processes and performance.

Used pertinent data and facts to identify and solve a range of problems within area of expertise.

Investigated non-standard requests and problems, with some assistance from others.

Work exclusively within a specific knowledge area.

Prioritized and organized work to meet deadlines.

Provided explanations and information to others on topics within area of expertise.

Generally, work is Self-directed and not prescribed.

Works with less structured, more complex issues.

Pointed of contact for State Phone Survey, for providers in East Tennessee and large delegates: HPI/Wellmont and University Physicians Associates.

Additional Experience

Coventry Healthcare Credentialing Manager March 2008 – December 2009

Responsibilities:

Managed the daily credentialing and re-credentialing activities for the Credentials Verification Center to ensure compliance with all regulatory agencies.

Amerigroup Community Care January 2007 – February 2008

Provider Representative Management

Responsibilities: Ensure that provider relationships with the Plan are positive and productive for both parties.

HCA October 2003 - December 2006

Credentialing Manager

Responsibilities:

Responsible for enrollment and credentialing of physician groups and individual practices.

Provider Enrollment Data Coordinator

Responsibilities:

Maintained and supported Provider Enrollment systems and software, including problem resolution, program implementation and software and database maintenance.

Provider Enrollment Credentialing Specialist

Responsibilities:

Effectively managed contracts for over 100 health care providers through 7 regional territories for over 30 payors/payers resulting in timely payments of claims.

Universal Care of Tennessee June 2001 - May 2003

Senior Provider Representative

Responsibilities:

Monitored and ensured that individual Provider Representatives were maintaining their counties and tasks in compliance with all company policies and procedures.

Provider Representative Management

Responsibilities:

Responsible for establishing and maintaining solid relationships with physicians’ groups, hospitals and ancillary providers.

Health 123 September 1998 - May 2001

Network Management Representative

Responsibilities:

Assessment of the effectiveness of Provider Agreements and recommendation of changes when necessary.

Contract Specialist

Responsibilities:

Responsible for the review and analysis of provider contracts.

GAB Healthcare August 1997 – September 1998

Unit Team Leader

Responsibilities:

Coordinated internal and external workflow for 13 data entry people.

Claims Administrator

Responsibilities:

Processed 150 – 200 physicians, ancillary and hospital claims for reimbursement daily.

Utilized and reviewed CPT Codes, ICD-9 Codes, DRGs and Revenue Codes for claim administration.

Cigna Healthcare December 1993 – May 1997

Hospital/Ancillary Data Administrator

Responsibilities:

Maintained and ensured the accuracy of Hospital and Ancillary Contracts arrangements in all CIGNA Systems.

Education:

Attended Middle Tennessee State University

References: Available upon request

Contact this candidate