Senior Provider Relations Advocate Resume Samples

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DH
D Hammes
Dillon
Hammes
96247 Metz Point
San Francisco
CA
+1 (555) 959 9742
96247 Metz Point
San Francisco
CA
Phone
p +1 (555) 959 9742
Experience Experience
New York, NY
Senior Provider Relations Advocate
New York, NY
Ebert, Collier and Farrell
New York, NY
Senior Provider Relations Advocate
  • Develop and maintain high profile provider relationships
  • Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
  • Develops an intimate knowledge of the Providers’ practice
  • Work with minimal guidance; seek guidance on only the most complex tasks - Provide explanations and information to others on difficult issues
  • Travel to Provider locations in Long Island and/or downstate NY to achieve above goals
  • Develops an intimate knowledge of the Hospital team
  • Performs all other related duties as assigned
Chicago, IL
Senior Provider Relations Advocate, Hospital
Chicago, IL
Hickle Group
Chicago, IL
Senior Provider Relations Advocate, Hospital
  • Present regional and market level performance reports to management on project updates, project cycle, and expected results
  • Attend provider expos, events and seeks out opportunities to hold provider lunch and learn events
  • Identify opportunities for process improvements for the assigned market and communicates effectively with associates and manager
  • Support Provider issue resolution with internal teams and follow up with providers to close the loop of issues
  • Support the education and support of providers across all lines of business
  • Take time to understand the challenges faced by the Provider specific to administration simplification, Healthcare Reform, etc
  • Develop an intimate knowledge of the Hospital team
present
San Francisco, CA
Senior Provider Relations Advocate Telecommute
San Francisco, CA
Bruen and Sons
present
San Francisco, CA
Senior Provider Relations Advocate Telecommute
present
  • Coach, provide feedback, and guide others
  • Provide explanations and information to others on difficult issues
  • Work with minimal guidance; seek guidance on only the most complex tasks
  • Translate concepts into practice
  • Solve moderately complex problems and / or conduct moderately complex analyses
  • Identify solutions to non-standard requests and problems
  • Provide training and education to physician and ancillary providers across all lines of business
Education Education
Undergraduate Degree
Undergraduate Degree
The Ohio State University
Undergraduate Degree
Skills Skills
  • Demonstrate flexibility and ability to work with both external and internal contacts
  • Work exclusively within a specific knowledge area
  • Investigate non-standard requests and problems, with some assistance from others
  • Act as a resource for others with less experience
  • Identify solutions to non-standard requests and problems
  • Position generally is on road with provider visitation 3 days a week. One day work at home and one day in office. This can be discussed with each candidate depending on location
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Provide explanations and information to others on difficult issues
  • Work with minimal guidance; seek guidance on only the most complex tasks
  • Prioritize and organize own work to meet deadlines
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3 Senior Provider Relations Advocate resume templates

1

Senior Provider Relations Advocate Resume Examples & Samples

  • Present regional and market level performance reports to management on project updates, project cycle, and expected results
  • Support the education and support of providers across all lines of business
  • Monitor industry trends and resources and defines opportunities to enhance provider service offerings
  • Attend provider expos, events and seeks out opportunities to hold provider lunch and learn events
  • Work closely with other market advocates and leaders to seek opportunities to further enhance the providers experience with UnitedHealthcare
  • Take time to understand the challenges faced by the Provider specific to administration simplification, Healthcare Reform, etc
  • Understand the changing healthcare landscape
  • 4+ years of experience with provider relations, provider network and/or provider network management
  • 3 years of experience with claims processing and issue resolution
  • Intermediate level of proficiency with Microsoft Word and Excel
2

Senior Provider Relations Advocate, Hospital Resume Examples & Samples

  • Develop an intimate knowledge of the Hospital team
  • Bring the "voice of the provider" to help shape outreaches being undertaken by UHG
  • Experience with in claims processing and issue resolution
3

Senior Provider Relations Advocate Resume Examples & Samples

  • Demonstrated ability to build strong relationships with providers and with internal departments
  • 2+ years of experience with Medicare and Medicaid regulations
  • Intermediate level of proficiency in billing/coding/claims analysis; claim issue resolution
  • 2+ years presentation experience
  • Intermediate level of proficiency with MS Excel
  • Previous experience with providers in this region
  • Previous Provider Relations experience at the facility level
  • Solid organization and planning skills
4

Senior Provider Relations Advocate Resume Examples & Samples

  • Develops an intimate knowledge of the Hospital team
  • Bring the “voice of the provider” to help shape outreaches being undertaken by UHG
  • 4+ years of experience with provider relations, provider network and / or provider network management
5

Senior Provider Relations Advocate Resume Examples & Samples

  • Frequent face to face meetings with Empire Plan, UnitedHealthcare Providers
  • High quality work and attention to detail
  • Speak and communicate effectively
  • Experience with Contracting, Fee Negotiation and relationship building in Provider Community
  • Ability to travel locally 50% of the time
  • Proficiency in claims processing and issue resolution
  • MS Access
6

Senior Provider Relations Advocate Resume Examples & Samples

  • Work closely with the contracting team in San Antonio and counter-part in the Austin Market
  • 3+ years of experience with Medicare and Medicaid regulations
  • 1+ year of presentation skills utilizing Power Point, presenting to all levels
  • 2+ years of experience with using reporting tools such as Excel or Access
7

Senior Provider Relations Advocate Resume Examples & Samples

  • Provider Advocate will be required to travel to assigned physician groups within territory
  • Undergraduate degree or equivalent
  • 2+ years of provider relations and/or provider network experience
  • 2+ years experience with Medicare and Medicaid regulations
  • Working knowledge of Physician Contracting
8

Senior Provider Relations Advocate Resume Examples & Samples

  • Must have strong knowledge of Hospital claims and processing guidelines
  • 3+ years of experience with Medicare regulations
  • Ability to prioritize and meet deadlines from multiple levels of staff members within the department
  • Proficiency with MS Outlook, Word, Excel, PowerPoint and SharePoint
  • Ability to travel regionally up to 25%
  • Experience with Medicaid regulations
  • Proficiency with MS Access
  • Experience with the following platforms: Nice, NDB, Emptoris, Facets, POPS
9

Senior Provider Relations Advocate Telecommute Resume Examples & Samples

  • Identify solutions to non-standard requests and problems
  • Solve moderately complex problems and / or conduct moderately complex analyses
  • 4+ years of provider relations and / or provider network experience with hospital and outpatient physician
  • Experience in a telecommute role
10

Senior Provider Relations Advocate Resume Examples & Samples

  • Demonstrate flexibility and ability to work with both external and internal contacts
  • Flexible with environment changes and needs, organized, motivated and self-starter
  • Position generally is on road with provider visitation 3 days a week. One day work at home and one day in office. This can be discussed with each candidate depending on location
  • Intermediate level of proficiency in billing / coding / claims analysis; claim issue resolution
  • Previous experience with providers in the state of MA
  • Experience with Skilled Nursing Facility provider relations
11

Senior Provider Relations Advocate Resume Examples & Samples

  • USA Telecommute**
  • Excellent problem solving & analytic skills
  • Ability to build strong relationships within and outside of Optum
  • Strong strategic and business acumen; well grounded in health care delivery systems
  • Capable of managing a variety of complex issues while driving momentum of key projects
  • Willingness to engage in business travel as applicable
  • Experience in Florida
  • Public Sector - Medicare and Medicaid experience
  • Experience with Claims review, research and analysis
  • Demonstrated ability to develop and maintain clinician and facility networks in previous position of Network Manager or equivalent in other equivalent environment
  • Behavioral Health experience preferred
12

Senior Provider Relations Advocate Resume Examples & Samples

  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • May be required to travel within assigned markets (field visits to provider locations)
  • 3+ years of experience with provider contracting/provider relations/provider network/provider data
  • Intermediate (or better) level of proficiency with MS Word and MS Excel (including use of filters, removing duplicates, converting text to columns, and basic formulas, etc.)
  • Field based travel may be necessary up to 50% of the time
  • Intermediate level of proficiency with MS PowerPoint and MS Access
  • 1+ years of experience with Medicare and Medicaid regulations
13

Senior Provider Relations Advocate Resume Examples & Samples

  • Travel to Provider locations in Long Island and/or downstate NY to achieve above goals
  • 1+ years developing and delivering presentations
  • Previous experience with providers in the territory
  • Ability to form strong, trusting relationships with providers
  • Demonstrated ability to communicate effectively verbally and in writing
14

Senior Provider Relations Advocate Resume Examples & Samples

  • Focus on this position is on hospital and facility provider service
  • 3+ years’ experience with Medicare and Medicaid regulations
  • Intermediate level of proficiency with MS Word & Excel
  • Experience dealing with hospital and facility claims
  • Experience with MS Access & PowerPoint
15

Senior Provider Relations Advocate Resume Examples & Samples

  • 4+ years of experience with provider relations and/or provider network
  • Must live within commutable distance of the location listed for this specific career opportunity
  • Understanding of the product lines and platforms associated with their portfolio of providers
16

Senior Provider Relations Advocate Resume Examples & Samples

  • Maintains and updates, through negotiation, all contracts prior to expiration. Seeks to negotiate changes that reduce financial and legal risks to the organization
  • Evaluates proposals for specialists, sub-capitated providers and some ancillary providers and recommends options based on costs, changes, services and needs of members
  • Acts as a resource to other internal department on payor issues and assures accurate implementation of contracts in addition to working with other departments to assure that appropriate mechanisms are in place to operationalize contracts
  • Seeks to reduce final risk by using data comparisons in the development and implementation of managed care strategies (i.e. contract negotiations) and communicates the results of data analysis and strategic planning to various audiences
  • Handles complex, difficult and/or routine provider inquires and/or problems and facilitates resolutions of provider issues, striving to ensure that favorable relationships are maintained
  • Conducts in-service education programs to providers regarding WellMed policies and procedures, ensuring delivery within the first quarter following execution of contract
  • Makes recommendations regarding reimbursement strategies to the appropriate manager and seeks ways to improve job efficiency
  • Maintains confidentiality at all times
  • Strives to personally expand working knowledge of all aspects of WellMed departments
  • Attends educational offerings to keep abreast of change and complies with licensing requirements
  • Performs all other related duties as assigned
  • Bachelor’s degree in a related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
  • Two or more years of network development experience
  • Ability and willingness to travel as determined by business need
  • Working knowledge of healthcare reimbursement practices, utilization management requirements, claims handling procedures, health insurance benefit administration and risk-based reimbursement
  • Experience in negotiating and implementing contractual arrangements
  • Progressive experience in a supervisory or managerial capacity
  • Ability to solve problems and deal with a variety of concrete variances in situations where limited standardization exists
  • Excellent written and presentation skills and the ability to easily communicate to diverse audiences
  • Ability to creatively exercise initiative, logic and sound judgment in the development of strategies and contractual relationships
  • Ability to organize and prioritize
  • Strong analytical and/or statistical skills
17

Senior Provider Relations Advocate, UHN SE Resume Examples & Samples

  • Educate providers on new programs / products or processes
  • Resolve outstanding claim concerns voiced by providers
  • Conduct moderately complex analyses
  • Work with minimal guidance; seek guidance on only the most complex tasks - Provide explanations and information to others on difficult issues
  • Work experience with UHG Claim systems
18

Senior Provider Relations Advocate Resume Examples & Samples

  • Will need to be located in Northern VA as this role will have a heavy emphasis on Fairfax County
  • Exceptional presentation, written and verbal communication skills with experience presenting in both large and small settings
  • Good organization and territory planning skills
  • Process/Project Management Skills
19

Senior Provider Relations Advocate Resume Examples & Samples

  • Intermediate level of proficiency with MS Word, Excel, PowerPoint,and Access
  • Previous Experience in a telecommuter role
  • Experience with OneNote
  • Currently residing in the Augusta/Athens, GA areas
20

Senior Provider Relations Advocate Resume Examples & Samples

  • High Volume, Intricate Detail, Analyzing Data, Strategy, Excel
  • 2+ years of experience in claims processing and issue resolution
  • 1+ year of experience with Medicare and Medicaid regulations
  • Intermediate level of proficiency with Excel, PowerPoint
  • Must have exceptional presentation skills, both written and verbal communication