Experience

Simply Healthcare Plans

• United States
• Insurance
• 200 - 300 Employee

• PROVIDER NETWORK MANAGER I

  • May 2018 - Present

  Tampa/St. Petersburg, Florida Area • Manage all contracted providers within the health plans network making sure they have access to all the required systems and reports generated by the health plan. • Maintained relationships with Providers, Vendors and Government Agencies – provided information and education to their staff regarding contracts, authorizations, claims procedures and regulatory requirements. • Negotiated fee for service and capitated contracts along with completing a full credentialing process for all new… Show more • Manage all contracted providers within the health plans network making sure they have access to all the required systems and reports generated by the health plan. • Maintained relationships with Providers, Vendors and Government Agencies – provided information and education to their staff regarding contracts, authorizations, claims procedures and regulatory requirements. • Negotiated fee for service and capitated contracts along with completing a full credentialing process for all new providers which includes PCP’s and Specialists. • Ability to manage multiple projects simultaneously, provided ongoing status updates and meet deadlines. • Resolved and prevented claims issues from occurring through research, coordination with other internal departments. • Collect Medical Records for the health plan during HEDIS season.

• Senior Configuration Specialist

  • Jan 2016 - Present

  Tampa/St. Petersburg, Florida Area • Responsible for maintaining accurate and timely maintenance of critical provider information on all claims and provider databases. • Validate data housed on provider databases ensuring adherence to business and system requirements of customers as it pertains to contracting, network management, and credentialing. • Ensure correct contracts are loaded in the providers database. • Train new employees on job duties. • Maintain communication with several departments within the company… Show more • Responsible for maintaining accurate and timely maintenance of critical provider information on all claims and provider databases. • Validate data housed on provider databases ensuring adherence to business and system requirements of customers as it pertains to contracting, network management, and credentialing. • Ensure correct contracts are loaded in the providers database. • Train new employees on job duties. • Maintain communication with several departments within the company (Provider Relations, Provider Administration, Credentialing and Member Services). • Maintain communication with the state of Florida regarding new or existing providers, ensuring they are registered with AHCA (Agency for Health Care Administration). • Responsible for reviewing and processing any encounter rejections with AHCA (Agency for Health Care Administration).



PK Management Group

• Field Asset Service Coordinator

  • Jun 2013 - Dec 2015

  • HUD state representative; manage properties in Indiana and Kentucky. • Manage a high volume of property work orders. • Order and oversee all property inspections and the preservation of properties in default/foreclosure, property preservation services, HUD services. • Negotiate pricing and research consumer information to assist in lowering project costs. • Ensuring the condition and appearance of the assigned properties is maintained.



Simply Healthcare Plans

• United States
• Insurance
• 200 - 300 Employee

• Member Services Representative

  • Feb 2012 - Jun 2013

  Coral Gables, Florida • Resolved complex customer service inquiries which included: benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, authorizations for treatments, and explanation of Benefits (EOB). • Constantly met established productivity, scheduled adherence, and quality standards.



24 Asset Management

• Real Estate
• 1 - 100 Employee

• Billing Department Processor

  • Jan 2010 - Jan 2012

  Miami, Florida • Responsible for reimbursing the contractors on property repairs. • Maintained communication with Real Estate agents regarding their reimbursements and financial documents. • Communicated with bank representatives at Fannie Mae regarding invoice approvals. • Processed and approved vendor preservations such as: grass cuts, door installations, lock changes, appliance installations, window installations, etc. • Handled direct vendor support and maintained open communication lines with… Show more • Responsible for reimbursing the contractors on property repairs. • Maintained communication with Real Estate agents regarding their reimbursements and financial documents. • Communicated with bank representatives at Fannie Mae regarding invoice approvals. • Processed and approved vendor preservations such as: grass cuts, door installations, lock changes, appliance installations, window installations, etc. • Handled direct vendor support and maintained open communication lines with bank representatives on a daily basis. Show less