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Work Background
PA Health & WellnessSenior Provider Engagement Account Manager
Feb. 2022Mechanicsburg, Pennsylvania, United States• Facilitates all contact between healthcare provider groups, practitioners, employees, and health plan staff in assigned territory.
• Supervises and leads educational training, including but not limited to, new provider group orientations and secure provider portal education, as well as internal new hire education and trainings. • Effectively and appropriately respond to external provider and practitioner outreach via email communication and by phone, as well as internal employee and cross-department communications.
• Guides resolution plans for provider related issues regarding claims, demographic/provider directory information, staffing, quality. • Manages field work via travel to hospitals, health system locations, provider groups, and individual practitioner offices to complete required provider on-site visits and educational trainings and maintain appropriate, meaningful contacts within the offices.
• Increased client satisfaction by building strong relationships and addressing their needs promptly.
• Manages Network performance for assigned territory through a consultative/account management approach
• Evaluates provider performance and develops strategic plan to improve performance
• Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution
PA Health & WellnessPROVIDER ENGAGMENT ADMINISTRATOR
Aug. 2019 - Feb. 2022Camp Hill, Pennsylvania, United States• Facilitated all contact between healthcare provider groups, practitioners, employees, and health plan staff. Oversaw the relationships between the health plan and employees of over 300 providers in the Lehigh Capital and Northeast Region zones in Pennsylvania. Supervised and lead educational training, including but not limited to, new provider group orientations and secure provider portal education, as well as internal new hire education and trainings. Effectively and appropriately respond to external provider and practitioner outreach via email communication and by phone, as well as internal employee and cross-department communications. Guided resolution plans for provider related issues regarding claims, demographic/provider directory information, staffing, quality. Managed field work via travel (2019-2020) to provider group and individual practitioner offices to complete required provider on-site visits and educational trainings and maintain appropriate, meaningful contacts within the offices.
• Perform duties to act as a liaison between providers, the health plan and Corporate.
• Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
• Serve as primary contact for providers and act as a liaison between the providers and the health plan
• Conduct monthly face-to-face and virtual meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution.
UPMCINSURANCE REFERRAL & AUTHORIZATION SPECIALIST/TRAINER
May. 2015 - Aug. 2019Lemoyne, Pennsylvania, United States• Responsible for the coordination of the referral process within UPMC Pinnacle Health Medical Group.
• Responsible for coordinating specialty referrals and diagnostic authorizations and testing for the UPMC Pinnacle Health sites and outside facilities.
• Pre-certifies diagnostic testing, as required by patient's insurance. Educates the patients on various policies, procedures, and benefits, related to the need for referrals and authorizations.
• Works closely with insurance companies, identifying, verifying, and applying insurance coverage for patients.
• Coordinates referrals and authorizations with patients and specialist's offices, and processes insurance referrals as required.
• Acts as a liaison between patient, physician, specialist, and insurance company.
• Handles multi-line phones, telephone calls, messages, and communicates with other members of medical team regarding patient care. Including faxing, filing, and typing, sending business correspondence.
• Updated confidential client information files, scanned documents into patient charts, and managed files as needed.
• Obtained, released and scanned medical
• records.
• Communicates with supervisors and peers about documenting and recording patient files and otherwise obtaining information from other medical facilities.
• Resolves conflicts, settled disputes and insured patient satisfaction.
• Ensures accurate data entry and completion of
• authorization from referral/authorization forms, medical documentation.
• Contacts providers to obtain missing medical documentation to assure compliance with timelines.
• Efficiently uses Epic (Electronic Medical Record software) to assist physicians and patients in various aspects.
• On-boarding mentor and trainer for new staff. Oversees training for new hires within the department and handles IT issues.
• Developed training guidelines and procedures for the UPMC PHMG Referral Departments in Harrisburg, Lancaster, York, Carlisle, and Hanover
UPMCPATIENT SERVICES REPRESENTATITVE
Dec. 2014 - May. 2015Millersburg, Pennsylvania, United States• Responsible for aiding patients throughout all phases of medical treatment.
• Maintained patient confidentiality by adhering to HIPAA regulations and diligently updating records as needed.
• Resolved patient complaints promptly, demonstrating empathy and understanding while seeking mutually beneficial solutions.
• Managed high call volume, prioritizing urgent issues and directing calls appropriately for optimal resolution.
• Implemented effective time management strategies that allowed me to balance multiple responsibilities, resulting in improved productivity and patient satisfaction.
• Provided exceptional customer service to build strong relationships with patients, leading to increased loyalty and return visits.
• Improved patient satisfaction by efficiently managing appointment scheduling and coordinating follow-up care.
• Conducted pre-registration tasks including verifying insurance eligibility requirements were met before scheduled appointments.
• Increased efficiency of office operations through proper management of medical records and filing systems.
• Served as a key point-of-contact between physicians, nurses, technicians, administrators, other professionals involved in the provision of quality medical services.
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