Provider Relations Advocate Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the provider relations advocate job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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TS
T Schaefer
Tamia
Schaefer
86043 Thomas Garden
Los Angeles
CA
+1 (555) 640 0649
86043 Thomas Garden
Los Angeles
CA
Phone
p +1 (555) 640 0649
Experience Experience
12/2016 present
Boston, MA
Senior Healthcare Provider Relations Advocate
Boston, MA
Senior Healthcare Provider Relations Advocate
12/2016 present
Boston, MA
Senior Healthcare Provider Relations Advocate
12/2016 present
  • Bring the ‘voice of the provider’ to help shape outreaches being undertaken by UHG
  • Provide explanations and information to others on difficult issues
  • Work with minimal guidance; seek guidance on only the most complex tasks
  • Attend provider expos, events and seeks out opportunities to hold provider lunch and learn events
  • Coach, provide feedback, and guide others
  • Generally work is self-directed and not prescribed
  • Work with less structured, more complex issues
10/2011 10/2016
New York, NY
Dental Provider Relations Advocate
New York, NY
Dental Provider Relations Advocate
10/2011 10/2016
New York, NY
Dental Provider Relations Advocate
10/2011 10/2016
  • Provider relationship manager
  • Network adequacy manager
  • Prioritize and organize own work to meet deadlines
  • Special project manager
  • Work exclusively within a specific knowledge area
  • Provide explanations and information to others on topics within areas of expertise
  • Provider at risk escalation resource
11/2004 04/2011
Detroit, MI
Provider Relations Advocate
Detroit, MI
Provider Relations Advocate
11/2004 04/2011
Detroit, MI
Provider Relations Advocate
11/2004 04/2011
  • Collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans
  • Implementing strategies relating to the development and management of a provider network, and identifying gaps in network composition and services
  • Evaluate and provide feedback to improve performance of provider support personnel, inclusive of clinical and non-clinical personnel
  • Responsible for developing and building relationships with non-Tier 1 physician, hospital and ancillary providers, out of state providers and non-par providers
  • Directs and implements strategies relating to the development & management of a provider network
  • Assists and / or monitor Provider Network development and handles follow - up activities
  • Directing and implementing strategies relating to the development and management of a provider network
Education Education
Undergraduate Degree
Undergraduate Degree
Tulane University
Undergraduate Degree
Skills Skills
  • Work exclusively within a specific knowledge area
  • Ability to prioritize and meet deadlines from multi-staff members within the department
  • Good organization and planning skills
  • Ability to work independently and remain on task
  • Assists manager in implementing provider recruitment and contracting, and oversees the updating of data, coding and billing as applicable
  • Builds and maintains productive and collaborative relationships with network providers and their administrative staff
  • Telecommuter based in Central NY (Syracuse NY) 25%-50% travel throughout the Central NY area
  • Completes and /or monitors administrative processes related to the application, credentialing, contacting and re-credentialing of providers
  • Reviews and / or monitors all provider applications and supporting documents to ensure compliance with the credentialing criteria for inclusion in the different networks
  • Tracks and / or monitors credentialing process and sends provider the completed contract once process is completed
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1

Senior Healthcare Provider Relations Advocate Resume Examples & Samples

  • Provide explanations and information to others on difficult issues
  • Support multiple on going projects, across 12 States in Northeast and Mid Atlantic region
  • Generally work is self-directed and not prescribed
  • Work with less structured, more complex issues
  • Serve as a resource to others
  • Field-based; Frequent on-site visits and meetings with physician groups or hospital systems. Large complexity, high volume, high spend provider groups or specialties
  • This position is a telecommute role but candidates must be located in the Northeast or Mid-Atlantic regions of the US. The position supports behavioral health providers in those regions and must be able to travel to those regions. Relocation assistance has not been budgeted for the role.**
  • Intermediate level of proficiency in claims processing and issue resolution
  • Exceptional presentation, written and verbal communication skills
  • Ability to prioritize and meet deadlines from multi-staff members within the department
2

Provider Relations Advocate Resume Examples & Samples

  • Work closely with other market advocates and leaders to seek opportunities to further enhance the providers experience with United HealthCare
  • Demonstrate an expert understanding of claims processes and can work through problems to find a solution
  • Demonstrates the ability to use data analytics to solve problems
  • Build relationships with hospitals and internal contacts
  • 4+ years of experience working with physicians, hospitals, health systems, or managed care
  • Understands all of the product lines and platforms associated with their portfolio of providers
3

Senior Healthcare Provider Relations Advocate Resume Examples & Samples

  • Manage and support Advocate initiatives to achieve measurable improvements in the provider service experience for the market
  • Support Provider issue resolution with internal teams and follow up with providers to close the loop of issues
  • Coordinate extensively with internal leads to provide to gain a full understanding of assigned core account portfolio and challenges
  • Bring the ‘voice of the provider’ to help shape outreaches being undertaken by UHG
  • Demonstrate the ability to use data analytics to solve problems
  • Undergraduate degree or equivalent combination of education and relevant experience
  • 2 years of experience in an outward facing role
  • Experience creating and delivering presentations
  • Understanding of all of the product lines and platforms associated with their portfolio of providers
4

Healthcare Provider Relations Advocate Resume Examples & Samples

  • Intermediate level of proficiency with MS Excel and Word
  • 1+ years of COSMOS
  • 1+ years of claims processing and / or adjustment experience
5

Provider Relations Advocate Northeast Ohio Resume Examples & Samples

  • Work exclusively within a specific knowledge area
  • 2+ years of healthcare provider relations and/or provider network experience
  • Intermediate level of proficiency with MS Word and Excel
  • Ability to travel up to 25% regionally within Trumble, Mahoning and Portage counties
  • Knowledge of Long Term Care, Skilled Nursing Facilities, and/or Nursing Homes is desirable
  • Experience with Medicare and Medicaid regulations
  • Proficiency with MS PowerPoint
6

Provider Relations Advocate Resume Examples & Samples

  • Visit provider groups for on-site service calls to update office staff on UHCCP products, administrative and claims procedures, and current coding issues pertaining to Medicaid and Medicare products
  • Visit newly contracted providers within 30 days of contract implementation. Work to resolve potential problems before they become an issue with the provider groups and work to ensure satisfaction with UHCCP
  • Provide follow-up on behalf of UCCP departments regarding participating providers’ contract questions or compliance issues
  • Act as a liaison for UHCCP between provider groups, members, and UHCCP to resolve problems and comply with requests
  • Communicate with provider offices and their staffs, internal departments, Program Network Integrity, and Provider Network Contract Account Lead. Document problems, issues, and resolution in provider files or call tracking as needed
  • Primarily responsible for the development and maintenance of the Provider Manual. Thoroughly explain the Provider Manual, provider contract, member plan information, and other information during on-site service calls and as needed, drawing on extensive knowledge of materials and policies. May assemble materials and other collateral information prior to delivery
  • Demonstrate proficiency in performing provider education and introductory meetings and presentations, including UHCCP mission and business, claims procedures, administrative procedures, member plan information, provider networks, and how to access appropriate forms and information on the UHCCP website. Prepare materials and presentations for the meetings
  • Speak as a UHCCP representative at provider-related functions. Attend provider-related conferences as a vendor in order to distribute information, network, and answer questions about UHCCP
  • Develop positive working relationships with provider groups and their staff to assure that providers’ concerns are addressed by the appropriate person(s) in a timely, responsive manner. Provide prompt, professional, and courteous service to providers, members, and UHCCP employees
  • As needed and consistent with proficiency and experience, participate in elements of training for employees who are new to the department
  • Meet department and company performance and attendance expectations
  • Bachelor’s Degree in a related field (Business Administration, etc.,) or equivalent experience
  • 3 years’ experience as a Provider Service Specialist within, or 5 years’ experience in related healthcare field
  • Excellent verbal and written communication skills with ability to prepare and execute group presentations
  • Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing
  • Ability to read, understand, and communicate provider contractual agreements and medical terminology proficiency
  • Demonstrated competency in Microsoft Office (MS Word, Excel, PowerPoint)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
7

Provider Relations Advocate Resume Examples & Samples

  • 50% of time is spent working with Providers / training office staff
  • Medicare Advantage experience would be preferred, but not required
  • Sales experience a plus
  • HEDIS, HCC and RAF knowledge
8

Healthcare Contracting & Provider Relations Advocate Resume Examples & Samples

  • Draft provider contracts and amendments and Memoranda of Understanding for review and approval, and preparing / coordinating document packets for delivery, signature and return on timely basis
  • Provide administrative, operational, analytic and decision-making support regarding provider contracting, contract deliverables and related matters. This will be achieved through ensuring providers submit contract deliverables on a timely basis through monitoring due dates, documenting the receipt of deliverables and filing appropriately
  • Review compliance of contract deliverables; prepare state contract deliverables for submission; identify new/revised provider and network requirements through review / analysis of new state contracts and amendments, memoranda of understanding, laws and regulations, government manuals and company guidance; assist in review and analysis of state contracts and amendments under negotiation; cultivate and maintain positive, constructive and professional internal and external working relationships with internal and external parties related to responsibilities / unit
  • Provider relations / contract / network administration functions as assigned by the Provider Relations Manager
  • Assist in the review and assessment of provider network adequacy / accessibility
  • Conduct initial review of provider agency network applications and attached documents
  • Assist in periodic review of provider performance and compliance
  • Manage a federal block grant program administered by Optum Pierce BHO
  • Serve as the grant program expert regarding the program’s mission, goals and objectives; state block grant contract and block grant provider contracts; annual block grant plan; federal and state regulations and guidance about grant program requirements; monitoring of grant provider performance and expenditures through review of monthly reports against projections; identify when a provider is not meeting performance and expenditure projections
  • Prepare grant performance reports, including updates presented to advisory committee and reports submitted to state
  • Advanced written skills, especially with drafting contract documents (including but not limited to terms & conditions, statements of work, attachments, exhibits, amendments), contract / provider related correspondence, provider forms, correspondence with state staff, reports for internal and external distribution; quickly create, compose and edit contract documents; and use professional language grammar, punctuation, formatting, editing and proof reading skills when preparing documents
  • Advanced verbal and interpersonal communication skills including speaking on the telephone, in-person meetings and presentations
  • Ability to quickly read, comprehend and analyze complex contracts
  • Follow instructions or work processes to learn and successfully perform job responsibilities in a timely manner
  • Work exclusively within a specific knowledge area, which includes providing information, updates, interpretations and explanations to supervisor or others
  • Embrace change in a fast-paced work environment where the operations and people have multiple competing priorities
  • Prioritize and organize own work to meet multiple deadlines and quickly re-prioritize when requested by management
  • Promote a positive, can-do attitude which inspires other team members
  • Experience in contract and amendment writing and preparation, general understanding of contract documents, contract provisions and language; ability to promptly review, comprehend and analyze complex state contracts with federal and state legal requirements that include provider contract requirements; understanding of managed care provider delivery systems, general understanding of public mental health and substance use disorder treatment systems administration / delivery or other complex health and human service systems
  • Paralegal experience drafting, revising, editing and preparing contracts and amendments for delivery, especially behavioral health or healthcare provider / health plan contracts
  • Experience composing and drafting provider contracts for a health plan / Medicaid plan, WA State DSHS, county human services department or Regional Support Network
  • Experience administering federal grant programs, including federal grant contracting, reporting and compliance with regulatory requirements
  • Experience with provider reimbursement, and ability to verifying / calculate correct dollar amounts are included in contract documents
  • Ability to handle change without complications
  • Experience and familiarity with federal and state statutes and regulations (USC, CFRs, RCWs and WACs) regarding managed Medicaid, public behavioral health, behavioral health agency and facility licensing and related topics
  • Experience administering federal grant programs, federal grant contracting, reporting and regulatory requirements
  • Experience working with behavioral health agencies, community mental health agencies, chemical dependency / substance use disorder treatment agencies
  • Advanced knowledge of Microsoft Word, Excel, PowerPoint, Outlook, Access, Visio
9

Provider Relations Advocate Resume Examples & Samples

  • This position is unique to ISNP facilities and Primary Care Physicians
  • Provider Advocates in this role are the critical link to membership growth and new business development as well as building and maintaining PCP relationships
  • 2+ years Provider Relations and / or Provider Network experience
  • Any previous experience with Medicare and Medicaid Regulations
  • Ability to utilize Microsoft Word to create general correspondence, update information within forms / templates, utilization of spell and grammar check
  • Ability to utilize Microsoft Excel to import data for reporting purposes, performing data entry, sorting/filtering, basic formulas and updating tables
  • Ability & willingness to travel approximately 75% within the State of Georgia
  • Ability to utilize Microsoft PowerPoint to create presentations from scratch, update/edit existing presentations or templates
  • Ability to utilize Microsoft Access to obtain data, generate reports, and export data to Excel for Analysis and reporting
  • Previous experience with SalesForce databases
10

Provider Relations Advocate Resume Examples & Samples

  • This role will manage our northern NJ skilled nursing facility network which encompasses approximately 90 facilities
  • The PRA will be responsible for end to end issue resolution, education of providers in their territory as well as project management
  • This is a remote role so the PRA must be able to work independently
  • Perform root cause analysis in order to resolve issues while addressing underlying disconnect
  • This is a client facing position so individual must be comfortable presenting to leadership of a facility which may include owners, CFO or any high level entity
  • Undergraduate degree or equivalent work experience
  • Must be able to perform root cause analysis in order to resolve issues while addressing underlying disconnect
  • Must be comfortable presenting to leadership of a facility which may include owners, CFO or any high level entity
  • Must live within commutable distance of one of the office locations listed for this specific career opportunity
  • Requesting the individual have administrative health care background such as previous provider relations experience or equivalent
11

Provider Relations Advocate Resume Examples & Samples

  • Investigate non-standard requests and problems , with some assistance from others
  • Associate degree or equivalent work experience
  • Intermediate level of proficiency with MS Word, Excel, Outlook and PowerPoint
  • Passion for teamwork, accountability, problem solving and customer service experience
  • Long term care and Skill Nursing Facility experience
  • Cosmos & Libertynet knowledge
  • Provider relations and / or provider network experience
  • MS Access experience
12

Provider Relations Advocate Resume Examples & Samples

  • Support Advocate initiatives to achieve measurable improvements in the provider service experience for the market
  • Develop an intimate knowledge of the Providers’ practice / Hospital team
  • Build relationships with providers and internal contacts
  • 2+ years of experience working with physicians, hospitals, health systems, or managed care
  • 2+ years of experience with in claims processing and issue resolution
  • 1+ years of experience in a client facing / customer service role
  • Understands all of the product lines and platforms associated with their portfolio of provider
13

Provider Relations Advocate Resume Examples & Samples

  • Working on end-to-end provider claim and call quality
  • Use of physician portal and future service enhancements
  • Training & development of provider education programs
  • Design and implement programs to build and nurture positive relationships between the health plan and providers
  • Directing and implementing strategies relating to the development and management of a provider network
  • Identifying gaps in network composition and services, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims
  • Experience with MS Office (Word, Excel, Powerpoint)
14

Provider Relations Advocate Resume Examples & Samples

  • Must be able to travel within the local RGV area
  • Associate's degree or equivalent work experience
  • 3+ years of provider relations or healthcare experience
  • Solid knowledge of the local provider community
  • Bilingual Spanish/English
  • 1+ years or experience with Medicare and Medicaid regulations
15

Provider Relations Advocate Resume Examples & Samples

  • 2+ years of provider network experience such as provider relations, contracting, credentialing, etc
  • 1+ year experience with Medicare and Medicaid regulations as well as Medicare Advantage plans
  • Must have access to reliable transportation and ability to travel up to 50% within El Paso County
  • Flexibility to working outside regular business hours (evenings / weekends) as needs require
  • Bilingual proficiency in Spanish / English
  • Knowledge of WellMed mission and model of care
16

Provider Relations Advocate Resume Examples & Samples

  • Working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of provider education programs
  • Design and implement programs to build and nurture positive relationships between the health plan and providersDirecting
  • Implementing strategies relating to the development and management of a provider network, and identifying gaps in network composition and services
  • Identifying and remediating operational short-falls and researching and remediating claims
  • Experience with MS Office (Word, Excel, PowerPoint)
17

Provider Relations Advocate Resume Examples & Samples

  • Telecommuter based in Central NY (Syracuse NY) 25%-50% travel throughout the Central NY area
  • Willing to travel locally 1 - 2 days per week
  • Experience with physician, skilled nursing facilities and ancillary
  • Proficient with MS Word, Excel and PowerPoint
  • Internal platforms experience such as COSMOS, NDB, FACETS, Emptoris, Salesforce.com, EDSS, IDRS and ISET
18

Provider Relations Advocate Resume Examples & Samples

  • Educate Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans
  • Ensures Providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives and patient care best practices
  • Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
  • Ensures the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others as needed
  • Participates in creation and execution of a local network development plan to assure network adequacy as needed
  • Works at the direction of their assigned leader to recruit/contract providers ensuring network adequacy
  • Conducts new provider orientations and ongoing education to providers and their staffs on healthcare delivery products, health plan partnerships, processes and compensation arrangements
  • Maintains open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality and risk adjustment programs
  • Conducts provider meetings to share and discuss economic data, troubleshoots for issue resolution, and implements an escalation process for discrepancies
  • Collaborates with provider groups to develop, execute and monitor performance and patient outcomes improvement plans
  • Collaborates with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
  • Handles or ensures appropriate scheduling, agenda, materials, location, meals and minutes of provider meetings as needed
  • Collaborates with contracting team to ensure provider data is correct and Provider directories include any needed updates. Completes Practitioner Data Forms and Provider Change Forms as needed
  • Represent WellMed / UHG by holding company sponsored Provider events (Summits, Learning Sessions)
  • Provides information and participate in management meetings as requested
  • Regularly meets with cross functional team to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals
  • Provider support to maintain and develop ongoing value related to the WellMed Value Proposition
  • Introduce and advocate company resources to facilitate practice optimization
  • Identifies at risk situations and develops a plan for escalation and corrective action
  • Associate’s degree or related experience
  • 3+ years of provider relations or managed care experience
  • Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff
  • Excellent analytical and problem solving skills with effective follow through
  • Solid knowledge of local provider community
  • Bachelor’s Degree with a significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
  • Presentation skills to small and large groups
  • Professional provider relations experience involving physicians and administrative staff
  • Provider recruitment and contracting experience
19

Provider Relations Advocate Resume Examples & Samples

  • Proficiency with MS Outlook, Word
  • Ability to travel regionally up to 25%, with overnight travel occasionally
  • Experience working in large matrixed organization
  • Proficiency with MS Excel, PowerPoint and SharePoint
  • Experience with the following platforms: ISET, Nice, NDB, Emptoris, Facets, POPS
20

Provider Relations Advocate Resume Examples & Samples

  • Analyze and investigate
  • Field-based; Frequent on - site visits and meetings with Physician groups or Hospital systems
  • Bachelor's Degree or equivalent years of experience
  • 1+ year of experience using Microsoft Word, Excel, and PowerPoint
  • 1+ experience working with Claims statuses or adjustments
  • 1+ year of experience Credentialing Providers
  • 2+ years of experience with Medicare regulations
  • 2+ years working in the California Market
  • WebEx experience
  • Experience presenting to groups
21

Healthcare Provider Relations Advocate Resume Examples & Samples

  • Experience working with a Physician office, Medical Group or Hospital
  • Prior billing office experience
  • Presentation skills preferred
22

Senior Healthcare Provider Relations Advocate Resume Examples & Samples

  • Ability to organize tasks in a fast paced environment and the ability to work well in a team
  • Speaking and presenting skills are essential
  • Coach, provide feedback, and guide other
  • 2+ years of provider relations and / or provider network experience
  • 2+ years of experience with commercial, Medicare and Medicaid products
  • Intermediate level of proficiency with MS Outlook, Word, Excel
  • Comfortable traveling approximately 50% of the time (local day travel with occasional overnights)
  • Proficiency with MS SharePoint, PowerPoint
  • Experience with ISET, Cosmos, Unet, CSP Facets, NDB
  • Knowledge of the Nebraska provider community
23

Provider Relations Advocate Resume Examples & Samples

  • Completes and /or monitors administrative processes related to the application, credentialing, contacting and re-credentialing of providers
  • Reviews and / or monitors all provider applications and supporting documents to ensure compliance with the credentialing criteria for inclusion in the different networks
  • Tracks and / or monitors credentialing process and sends provider the completed contract once process is completed
  • Runs and / or monitors reports from provider databases to track credentialing and re-credentialing activities for the variety of provider types
  • Returns and / or monitors the signed fully executed contract to new providers in the FFS and TERM networks
  • Tracks and / or monitors providers’ malpractice insurance, DEA, and licensure renewals to ensures they are current / active
  • Facilitates and/or monitors the resolution of credentialing issues and coordinates and completes external and internal termination notification requirements
  • Periodically review and/or monitor state and federal bulletins for provider sanctions; review provider disbarment reports and notify Manager of outcome
  • Attend and participate in meetings to achieve departmental and interdepartmental goals and objectives
  • Triages provider related issues and escalates complex problems when necessary to Manager
  • Respond to claim issues by assessing fee schedule and contract configuration, procedure and diagnosis code questions, review of modifiers and other claim form components, in order to determine payment accuracy
  • Builds and maintains productive and collaborative relationships with network providers and their administrative staff
  • Monitors clinician compliance with policies and procedures; provides education when necessary
  • Assists and / or monitor Provider Network development and handles follow - up activities
  • Organize and/or monitors provider files for ease of review by staff, credentialing committee and external review bodies
  • Accurately enters and maintains and / or monitors provider’s data into multiple databases resulting in accurate provider directories, provider payments, mailing labels and report information
  • Documents and/or monitors communication with providers in the designated databases; assists in managing the integrity of databases by using contacts with providers to verify and update provider files
  • Assists manager in setting team direction, resolving problems and provides guidance to provider services staff
  • Assists manager in developing departmental plans and priorities to address business and operational needs
  • Assists manager in implementing provider recruitment and contracting, and oversees the updating of data, coding and billing as applicable
  • Assists manager in providing clinical oversight of Provider Services Operations
  • Additional duties as necessary to successfully manage the provider networks and staff
  • Minimum of Master’s degree required
  • Proficiency in Microsoft applications required
  • Exceptional presentation, written and verbal communication skills required
  • Clinical licensure (LCSW, MFT, Ph.D., or MSN) preferred
  • Minimum 2 years of experience in the behavioral health managed care environment preferred
  • Experience working with state / county regulatory bodies strongly preferred
  • Supervisory or Team Lead experience preferred
  • Experience with provider contracting preferred
24

Provider Relations Advocate Resume Examples & Samples

  • 2+ years of healthcare provider relations and / or provider network experience
  • Ability to travel up to 25% regionally within Akron, Canton and Wooster area
  • Knowledge of Long Term Care, Skilled Nursing Facilities, and /or Nursing Homes is desirable
25

Provider Relations Advocate Resume Examples & Samples

  • Evaluate current performance of each assigned practice; establish goals unique to each practice with a focus on STARs and gap closure; ensure all applicable groups are performing at 4 stars or higher
  • Evaluate practice office operations with a focus on identifying barriers to achieving targeted outcomes
  • Evaluate and provide feedback to improve performance of provider support personnel, inclusive of clinical and non-clinical personnel
  • Ensure providers understands incentive opportunities and receive ongoing feedback and report cards designed to motivate and optimize provider incentive payouts
  • Ensure providers are aware of Plan sponsored initiatives designed to assist and empower members in closing gaps (Member Rewards, Hi Health Innovation, vision, fitness, Renew, Housecalls)
  • Identify opportunities for provider and Plan to join forces in achieving targets, such as sponsorship of wellness day, co - branding, etc
  • Ensure all claims based issues are triaged to the appropriate party for claims analysis and resolution; ensure timely resolution of all issues brought forth
  • Maintains education/knowledge base of HEDIS / STARs standards and guidelines
26

Provider Relations Advocate Resume Examples & Samples

  • Work with minimal guidance; seek guidance on only the most complex tasks
  • Act as a resource for others with less experience
  • Travel within assigned market 3 days / week
  • 4+ years of provider relations and/or provider network experience
  • Project Mgmt
27

Provider Relations Advocate Resume Examples & Samples

  • Directs and implements strategies relating to the development & management of a provider network
  • Identifies gaps in network composition and services
  • Assists the Network Contracting and Development staff in prioritizing contracting needs
  • Actively involved in identifying and remediating operational short-falls
  • Researches and remediates claims
  • Uses pertinent facts & data to identify and solve a range of problems within area of expertise
  • Frequent on-site visits & meetings with Missouri physician groups or hospital systems
  • Bachelor's degree or equivalent years of work experience
  • 2+ years of provider relations: medical/clinical office and/or provider network experience
  • Proficiency in MS Office (Outlook, Word, Excel, PowerPoint)
  • 1+ experience working with claims (i.e., statuses, adjustments, etc.)
  • 1+ year of experience credentialing providers
  • Able to travel within Missouri market area
  • Experience presenting to groups including senior leadership and C- level executives
  • Knowledge of medical terminology and CPT / ICD-9 coding
28

Healthcare Provider Relations Advocate Resume Examples & Samples

  • Outward facing experience with providers (preferable)
  • Prior medical billing or medical back office experience (preferable)
  • Ability to travel 50% of time
  • Bachelor's degree or equivalent on-the-job experience
29

Provider Relations Advocate Resume Examples & Samples

  • Travel within assigned market as required
  • 3+ years of experience and proficiency in claims processing and claims-related issue resolution or professional claims billing experience while working for a medical and/or billing organization
  • Ability to communicate highly complex issues and have flexibility to translate them in a manner that can be understood at all levels within a matrix organization
  • Intermediate level of proficiency with MS Excel required, advanced level proficiency with Excel preferred
30

Provider Relations Advocate Resume Examples & Samples

  • Frequent on-site visits & meetings with physician groups or hospital systems
  • 2+ years of provider relations: medical / clinical office and/or provider network experience
  • Able to travel within Kansas or Illinois market area
31

Provider Relations Advocate Resume Examples & Samples

  • Participate in face to face provider visits within your assigned territory
  • Develop an intimate knowledge of the Providers’ practice
  • Ability to travel up to 50% of the time for required face to face visits with providers
  • Previous Medicaid experience (either on the payer or provider side)
  • Experience with CSP Facets, Cosmos, NDB, and/or UNET
32

Provider Relations Advocate Resume Examples & Samples

  • Provide training and education to physician and ancillary providers across all lines of business
  • Investigate non-standard requests and problems with some assistance form others
  • Travel for face to face visits with providers within the San Diego market
  • 3+ years of provider relations and/or provider network experience
  • Experience with claims processing and issue resolution
  • Intermediate level of proficiency with MS Word, Excel and PowerPoint
  • Experience with Access, NDB, Nice, Pulse, Iset, Unet, Cosmos, Impact, and/or IBAAG
33

Provider Relations Advocate Resume Examples & Samples

  • 2+ years of Provider Relations and/or Provider Network experience
  • Experience in Claims processing and issue resolution
  • Experience using a computer and Microsoft Word, Excel and PowerPoint
  • Comfortable traveling up to 25-30% of the time as needed
  • Knowledge of Autism / ABA (Applied Behavioral Analysis)
34

Provider Relations Advocate Resume Examples & Samples

  • CPM, MSA, Claims coding or claims research experience appreciated
  • 2+ years experience working with health insurance claims issue resolution
  • 1+ years experience delivering presentations (ideally to providers)
  • Intermediate level of proficiency with MS PowerPoint
35

Provider Relations Advocate Resume Examples & Samples

  • Responsible for developing and building relationships with non-Tier 1 physician, hospital and ancillary providers, out of state providers and non-par providers
  • Accountable for the full range of provider relations and service interactions with the provider s including working on end-to-end provider claim research and claims issue resolution, ease of use of physician portal and future service enhancements, and training & development of external provider education programs
  • Assists providers with UHG navigation
  • Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
  • May also be involved in identifying and remediating operational short-falls and researching and remediating claims
  • Assist preparing standard regulatory reports and may also assist with regulatory operational reviews and RFP responses related to network development and management
  • Acts as an operational resource to various departments and business partners related to Medicaid program requirements
  • Working knowledge of Medicare and Medicaid regulations
36

Provider Relations Advocate Resume Examples & Samples

  • Currently residing on Hawaii Island
  • Experience with Provider Data Collection
  • Experience with IMPACT and/or CSP Facets
37

Provider Relations Advocate Resume Examples & Samples

  • Medicaid billing knowledge
  • Knowledge and use of United Healthcare portals a plus
  • 2+ years of healthcare experience
  • Intermediate level of proficiency in claims knowledge and issue resolution
  • 1+ Nursing facility billing experience necessary
38

Provider Relations Advocate Resume Examples & Samples

  • The Physician Advocate role will be to support the Community and State line of business in the Sacramento market. This position will require heavy Medi-Cal experience specifically related to
  • The ability to travel up to 50% of the time within the Northern California territories
  • Experience with or knowledge of Medi-Cal Regulations
  • Experience with or knowledge of Federally Qualified Health Care Centers (FQHC?s)
  • Experience with and knowledge of Medi-Cal Claims process and billing
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Provider Relations Advocate Resume Examples & Samples

  • Collaboration with internal teams (clinical and sales)
  • View and analyze financial analysis
  • Ability to travel within Denver-Fort Collins, up to 50%
  • Experience with giving presentations
  • Previous experience working in / with skilled nursing facilities
  • Previous experience with medical billing / coding
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Provider Relations Advocate Resume Examples & Samples

  • Contract with appropriately credentialed state designated service providers and fiscal intermediaries for benefits related to assistive technology (beyond the scope of Durable Medical Equipment), community transitional services, moving assistance, home delivered / congregate meals and environmental and vehicle modifications
  • Maintain contracts with qualified providers and ensure compliance with state requirements
  • Develop standards to set up providers, rate tables and load appropriate rates for claims processing
  • Conduct monthly reconciliation / audit of submitted claims by contracted providers
  • Perform outreach and education to providers on policies and procedures to maximize the mutual benefit of a contractual relationship
  • Involve leadership and / or escalate issues as necessary to implement provider solutions
  • Basic understanding within Medicare and Medicaid guidelines
  • Beginner level of proficiency with MS Word and Excel
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Provider Relations Advocate Resume Examples & Samples

  • Contract with appropriately credentialed state designated service providers and fiscal intermediaries for benefits related to assistive technology (beyond the scope of Durable Medical Equipment), community transitional services, moving assistance, home delivered/congregate meals and environmental and vehicle modifications
  • Conduct monthly reconciliation/audit of submitted claims by contracted providers
  • Involve leadership and/or escalate issues as necessary to implement provider solutions
  • Conduct periodic field visits to provide ongoing education to providers
  • Basic understanding of Medicare and Medicaid guidelines
  • Ability to travel about 25%
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Provider Relations Advocate Resume Examples & Samples

  • Bachelor's Degree OR equivalent work experience
  • 3+ years of experience working within the Healthcare field
  • Ability to travel up to 25% regionally within Cleveland
  • Ability to work independently and remain on tasks
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Provider Relations Advocate Telecommute Resume Examples & Samples

  • 2+ years of provider contracting, provider relations and / or provider network experience
  • 1+ years of experience with Medicare and Medicaid regulations, including knowledge of payment guidelines and reimbursement methodologies such as DRGs, RUGS, etc
  • Familiarity with local and national market trends in skilled nursing community and in managed care industry
  • Intermediate level of proficiency with MS Word, Excel
  • Ability to travel about 75% for provider visits
  • Skilled nursing industry experience
  • Proficiency in MS PowerPoint and Access
  • Experience with NDB, Cosmos
  • Ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Strong customer service skills and ability to manage multiple priorities and rapid change
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Dental Provider Relations Advocate Resume Examples & Samples

  • Use pertinent data and facts to identify
  • Solve a range of problems within area of expertise
  • Investigate non-standard requests and problems with some assistance from others
  • Provide explanations and information to others on topics within areas of expertise
  • Position being hired is dedicated to Dental; government programs
  • FQHC relationship owner
  • Provider relationship manager
  • Spot recruitment
  • Provider training
  • Provider at risk escalation resource
  • Member escalation contact
  • Network adequacy manager
  • Special project manager
  • Market expert
  • Training, when applicable to providers
  • Medicaid plan and benefit understanding
  • Clinical exposure
  • Work and document interactions and issues in multiple systems
  • 1+ years’ experience in a network management related role, such as contracting or provider services
  • In-depth knowledge of Medicaid and Medicare reimbursement methodology (i.e. APG, PPS, FFS, Capitation)
  • Knowledge of PPO reimbursement methodologies
  • Knowledge of claim processing systems and guidelines
  • Currently reside in service area of downstate NY, preferably one of the 5 boroughs of New York City
  • Must have reliable transportation for local travel up to 50% of the time
  • Previous experience in the dental industry Excellent verbal and written communication skills
  • Ability to speak clearly and concisely, conveying -complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
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Healthcare Provider Relations Advocate Resume Examples & Samples

  • Provide explanations and interpretations within area of expertise
  • Regularly field-based; frequent on-site visits and meetings with Federally Qualified Health Centers, Community Mental Health Clinics, Physician groups or Hospital systems. Smaller practices, lower spending & less complexity
  • 2+ years of Provider Relations and / or Provider Network experience
  • Basic proficiency using Microsoft Word, Excel, and PowerPoint
  • 1+ year of hands on experience working with claims statuses or adjustments
  • Familiarity with Provider Credentialing
  • 2+ years of experience with Medi-Cal and Medicare regulations
  • 2+ years working in the San Diego or Sacramento California healthcare markets
  • Ability to travel approximately 20% of the time
  • Experience with Behavioral Health
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Provider Relations Advocate Resume Examples & Samples

  • Offer knowledge regarding Medi - Cal Regulations
  • Providing support for Federally Qualified Health Care Centers (FQHC's)
  • Medi - Cal Claims process and billing
  • Working with individual physician offices and understanding their practice management operations and systems
  • 3+ years of provider relations and / or provider network experience
  • Experience with or knowledge of Medi - Cal Regulations
  • Experience with or knowledge of Federally Qualified Health Care Centers (FQHC's)
  • Experience with and knowledge of Medi - Cal Claims process and billing
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Provider Relations Advocate Resume Examples & Samples

  • Assist team members to ensure they meets or exceed established CPM productivity and TAT goals
  • Accountable for assisting team members with claim projects reviews, including end to end process, from initial communication, identification of claim payment issue, facilitation of resolution of claim payment issues and communication of outcome
  • Ability to educate provider on details of UHG reimbursement policies
  • Understand and specializing in multiple markets with the intent to know and understand the physicians, facilities and ancillary providers and the nuances of their contracts and the related claim issues
  • Interact directly with market providers and internal office staff in the resolution of claim issues
  • Research claims to determine accuracy and identify high level root cause of any claim payment issues
  • Ensure team members are providing consistent quality service to UHGs customers
  • Research complex issues while navigating multiple platforms and databases
  • Collaborate with management and other business partners to gather data needed for resolution
  • Proficiency in the UNET system
  • Vast knowledge of the CPM end to end process and metrics, showing history of achieving all metrics and effectively managing inventory
  • Ability to provide consistent coaching and feedback to CPM Team members, while maintaining confidentiality of those interactions
  • Ability to trend, analyze and make suggestions for process improvements
  • Ability to work effectively with internal and external business partners
  • Excellent analytical and problem solving skills that enable quick identification of root cause and the ability to effectively bring to resolution
  • Ability to multitask effectively and demonstrate a positive outlook in our ever changing environment
  • Ability to assist Team members with Provider interactions that become escalated or difficult
  • 1+ years of experience with Medicare regulations
  • Exposure or experience with COSMOS
  • Strong technical skills along with claim knowledge and the ability to research issues independently
  • Highly motivated, organized and flexible
  • Ability to maintain positive and professional demeanor even when interactions become difficult
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Provider Relations Advocate Resume Examples & Samples

  • Able to multi task in fast paced environment and be part of a team
  • 1+ years’ experience with Medicare and Medicaid regulations
  • \Ability to work independently and remain on task
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Provider Relations Advocate Resume Examples & Samples

  • Proficiency with MS Outlook, Word, Excel
  • Ability to travel regionally approximately 5%
  • Ability to obtain favorable adjudication following submission of Department of Defense eQuip Form SF86
  • Proficiency with MS PowerPoint and SharePoint
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Senior Healthcare Provider Relations Advocate Telecommute Resume Examples & Samples

  • Self - motivated employee as this will be a telecommuter position
  • The applicant will service providers within the Oklahoma City, OK, region
  • Ability to travel regionally about 25%