Provider Relations Advocate Resume Sample
Jamir Strosin
9487 Luciano Dam,
Dallas,
TX
+1 (555) 486 5245
Work Experience
Senior Healthcare Provider Relations Advocate
03/2018
-
PRESENT
Chicago, IL
- Bring the ‘voice of the provider’ to help shape outreaches being undertaken by UHG
- Provide follow-up on behalf of UCCP departments regarding participating providers’ contract questions or compliance issues
- 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
- Experience with hospital/ancillary billing practices and provider relations
- Understand how a providers office operates and understands their challenges
- Develop an intimate knowledge of the Providers’ practice / Hospital team
- Tracks and / or monitors providers’ malpractice insurance, DEA, and licensure renewals to ensures they are current / active
- 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
- Collaborates with contracting team to ensure provider data is correct and Provider directories include any needed updates
Provider Relations Advocate
12/2014
-
01/2018
San Francisco, CA
- Develop an intimate knowledge of the Providers’ practice
- Prioritize and organize own work to meet deadline
- Working knowledge of behavioral health
- Use pertinent data and facts to identify and solve a range of problems within are of expertise
- Represent WellMed/UHG by holding company sponsored Provider events (Summits, Learning Sessions)
- Frequent on-site visits and meetings with providers
- Communicate directly with providers (largely via phone and/or WebEx, with some occasional regional travel ) using pertinent data and facts to identify and solve a range of problems as they relate to Medicaid claims processing or related
- Communicate directly with providers (largely via phone and/or WebEx, with some occasional regional travel) using pertinent data and facts to identify and solve a range of problems as they relate to Medicaid claims processing or related
Healthcare Provider Relations Advocate
01/2011
-
07/2014
Phoenix, AZ
- Familiar with Medicaid is helpful but not required
- Consistently identify areas for process improvement that streamline processes
- Act as the main liaison between the provider network and the health plan in several markets within California
- Build and foster relationships that align partnerships and produce successful results
- Develop and foster relationships with Wyoming Medicaid Providers with in the region to include (but not limited to): Patient Centered Medical Homes, Other Primary Care Providers (Internal Medicine, Family Practice, OB/GYN, Pediatrics, etc.), Specialists, Hospitals, Nursing facilities, Behavioral Health Provider, Public Health Nursing
- Development and delivery of Provider Score Cards and Care Gap Reports
- Provider Newsletters and Bulletins
- Regional Provider Education and Training (CME, targeted education opportunities, etc.)
- Involvement in Community Baby Showers within the Region
Education
University of Mount Union
2005 - 2010
Bachelor's Degree in Health
Professional Skills
- Previous experience working in/with skilled nursing facilities
- Experience managing multiple priorities simultaneously while successfully meeting deadlines
- Past experience in skilled nursing facilities
- Demonstrated experience with making presentations to both small and large groups
- Provider relations/network management experience and/or provider-facing experience within a health plan environment
- Good keyboard/typing skills needed for success in role
- Experience in skilled nursing facilities
How to write Provider Relations Advocate Resume
Provider Relations Advocate role is responsible for travel, insurance, research, design, reporting, planning, recruiting, training, events, health.
To write great resume for provider relations advocate job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Provider Relations Advocate Resume
The section contact information is important in your provider relations advocate resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Provider Relations Advocate Resume
The section work experience is an essential part of your provider relations advocate resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous provider relations advocate responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular provider relations advocate position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Provider Relations Advocate resume experience can include:
- Provider billing, claims processing, or medical coding experience
- Provider relations activity for the free standing skilled nursing facility network in CA
- Work with minimal guidance and demonstrate an ability to remain on task while managing own workload, escalating appropriately
- Provider relations activity for the free standing skilled nursing facility network in NM
- Demonstrate a general understanding of claims processes and can work through problems to find a solution by leveraging the expertise of internal partners
- Previous experience with medical billing/coding
Education on a Provider Relations Advocate Resume
Make sure to make education a priority on your provider relations advocate resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider relations advocate experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Provider Relations Advocate Resume
When listing skills on your provider relations advocate resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical provider relations advocate skills:
- Billing and/or claims experience within assisted living home health, hospice or skilled nursing facility
- Experience as a Provider Service Specialist within, or 5 years’ experience in related healthcare field
- Prior experience with NICE, COSMOS, and/or NDB
- Prior experience with face to face provider visits
- Identify opportunities for process improvements for the assigned territory and communicates effectively with associates and manager
- Identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
List of Typical Experience For a Provider Relations Advocate Resume
1
Experience For Dental Provider Relations Advocate Resume
- Contribute to design and implementation of programs that build / nurture positive relationships between the health plan and the skilled nursing facilities
- Help drive improvements to provider and member satisfaction as it relates to managing the network and member interactions with our providers
- Educate key Nursing Home staff about United Healthcare systems
- Assist in end-to-end provider claims issue resolution and education in processing best practices
- Manage the credentialing process of new providers and facilitate changes as they occur
- Monitor member access to services and implement a recruiting strategy where gaps occur
- Manage fee schedules and updates to ensure accurate claims processing
- Coordinate extensively with internal leads to gain a full understanding of assigned core account portfolio and challenges
2
Experience For Healthcare Provider Relations Advocate Resume
- Work independently while demonstrating accountability for results without regular management supervision
- Occasionally help to identify gaps in network composition and services to assist network contracting and development teams
- Direct and implement strategies relating to the development and management of a provider network
- Currently residing on the island of Oahu
- At least an intermediate level of knowledge of claims/systems processes, contracting and reimbursement methodologies
- At least an intermediate proficiency in claims processing and issue resolution
3
Experience For Provider Relations Advocate Telecommute Resume
- Knowledge of the provider system serving children with behavioral health needs, in foster care and/or medically fragile
- At least an intermediate proficiency with MS Suite (including Word, PowerPoint and Excel)
- Proficiency in Medicaid in claims research including end-to-end issue resolution
- Proficiency with MS programs including Excel, PowerPoint and Word
- Proficiency in Medicaid in claims research, including end-to-end issue resolution
- Intermediate level of claims processing and issue resolution
4
Experience For Senior Healthcare Provider Relations Advocate Resume
- Act as a liaison between WYhealth Departments and Providers for directed provider outreach and education
- Attend Provider / Society / Association meetings as needed
- Use pertinent data and facts to identify and solve a range of problems within area of expertise within established timelines
- Provide explanations and information to others on topics within the area of expertise
- Produce in a very fast paced environment with a goal of provider satisfaction
5
Experience For Provider Relations Advocate / Network Manager Resume
- Act as the primary liaison between the provider and internal teams to ensure that provider issues are resolved timely
- Participate in Department / Company wide initiatives
- Assist in end-to-end provider claims and help enhance service quality
- Develop and foster relationships with Wyoming Medicaid Providers with in the region to include (but not limited to): Patient Centered Medical Homes, Other Primary Care Providers (Internal Medicine, Family Practice, OB / GYN, Pediatrics, etc…), Specialists, Hospitals, Nursing facilities, Behavioral Health Provider, Public Health Nursing
- Regional Provider Education and Training (CME, targeted education opportunities, etc….)
- Communicate directly with providers (largely via phone and / or WebEx, with some occasional regional travel ) using pertinent data and facts to identify and solve a range of problems as they relate to Medicaid claims processing or related
6
Experience For Senior Healthcare Provider Relations Advocate Telecommute Resume
- Identify gaps in network composition and services to assist network contracting and development team
- Assist in efforts to enhance ease of use of provider portal and future services enhancements
- Work with Minnesota providers in Advocate role
- Contribute to design and implementation of programs that build / nurture positive relationships between the health plan and providers
- Assist in end-to-end provider claims issues
- Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers (SNFs and PCPs), and practice managers
- Organize and lead provider and Joint Operations Committee (JOC) meetings, etc
- Maintain a comprehensive knowledge of providers in the region
7
Experience For Ancillary Provider Relations Advocate Resume
- Develop and maintain relations through regular visits and participation in regional committees and provider meetings
- Provider education/new provider orientation
- Claims research and resolution
- Liaison with various CA Health Plan departments
- Liaison with various NM Health Plan departments
- Proactively manages a portfolio of 40-45 provider groups within a defined geographic region
- Acts as a UHG "navigational" specialist
8
Experience For Provider Relations Advocate Northeast Ohio Resume
- Liaison with Account Manager and Health plan
- Represents Medicaid and Dual Special Needs Plan
- Single point of contact for provider escalated issues
- Educates providers on common billing practice errors, addresses questions related to affordability initiatives and reimbursement policies and drives adoption of self-service tools
- Assists in the end-to-end provider claims and help enhance service quality
- Conducts new provider education
- Conducts Site Visits / Assessments
9
Experience For Healthcare Contracting & Provider Relations Advocate Resume
- Engages in Spot Recruitment and Special Targeted Recruitment
- Assists with escalated member placement
- Attend provider expos, events and seeks out opportunities to hold provider
- Develop an intimate knowledge of provider practices
- Contribute to implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
- Recruit and negotiate rates with Providers
10
Experience For Provider Relations Advocate Resume
- Focus is on Behavioral Health Providers
- Communicate directly with providers (largely via phone and / or WebEx, with some occasional regional travel) using pertinent data and facts to identify and solve a range of problems as they relate to Medicaid claims processing or related
- Experience with Medicare and Medicaid regulations
- Claims resolution experience
- Medicare and Medicaid regulations experience
- Assist in efforts to enhance ease of use of physician portal and future services enhancement
- Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice manager
List of Typical Skills For a Provider Relations Advocate Resume
1
Skills For Dental Provider Relations Advocate Resume
- Experience delivering oral and written presentations and/or communicating with providers and other constituents
- Experience with SNF billing or coding procedures
- Provider relations, provider network, practice management, credentialing or contracting experience
- Knowledge of long term care, skilled nursing facilities, and/or nursing homes
- Experience in managing cross - functional projects and making presentations
- Be assigned a number Skilled Nursing Facilities to oversee on an ongoing basis
- Experience in a network management related role, such as contracting or provider services
2
Skills For Healthcare Provider Relations Advocate Resume
- Healthcare network management, contracting and / or a group provider relations experience
- Experience in provider education and / or conducting provider presentations
- Provider contracting, provider relations, and/or provider network experience in managed care industry
- Provider relations and / or provider network experience, including provider presentations
- Health care/managed care experience or in a sales/contracting role related to provider relations
- Demonstrated working knowledge of Medicare, HMO, fee for service, and delegated / capitated model reimbursement methodologies
3
Skills For Provider Relations Advocate Telecommute Resume
- Previous experience with at least one of the following systems/platforms such as NDB, Phycon, Impact, NICE, and/or UNet
- Provider relations and/or provider-facing network experience
- Experience with root cause analysis and troubleshooting
- Health care/managed care experience or in a sales/contracting role related to provider relations
- Provider credentialing experience
- Experience with Medicare and Medicaid regulations
- Experience with Medicare claims data and/or dual eligible cases
4
Skills For Senior Healthcare Provider Relations Advocate Resume
- Experience with IMPACT and / or CSP Facets
- Provider relations and / or provider network experience
- Experience with MediCal / Medicaid regulations
- Strong knowledge of County behavioral health and community services
- Experience with Medicaid regulations
- Experience NDB and Phycon
- Experience with FACETS, Salesforce and/or SCION
- Experience with claims resolution
- ) of experience with Medicare regulations
5
Skills For Provider Relations Advocate / Network Manager Resume
- Experience with NDB, ISET, and/or Impact
- Provider relations, customer service, and/or provider network experience
- Experience with Medicare and Medicaid plans
- Experience with United Healthcare’s system
- Long Term Care Support Services experience
- Employment and Community First experience
- Work experience with UHG Claim systems (COSMOS, UNET, NBD, etc)
- Experience with claims issue resolution
- Experience with providers within the state of California
6
Skills For Senior Healthcare Provider Relations Advocate Telecommute Resume
- ) of experience with Medicare and Medicaid plans
- ) of experience with Medicare and Medicaid regulations
- Dental office or dental claims experience
- Customer service/relationship management experience
- Health care/managed care experience
- Experience with claims and issue resolution
7
Skills For Ancillary Provider Relations Advocate Resume
- Health insurance industry experience
- Work independently, prioritize, and remain on task
- Behavioral Healthcare Experience
- Homecare and Hospice Experience
- Experience with Network Adequacy Analysis
- Health care/managed care experience
- Previous experience with HCBS (home and community based services) provider
- Provider advocate experience
8
Skills For Provider Relations Advocate Northeast Ohio Resume
- Autism / ABA experience
- Provider relations and /o r provider network experience
- Health care/managed care experience
- Provider relations and/or provider network experience
- Experience with Virginia Medicaid regulations
- Health care / managed care experience
- Prioritize and meet deadlines from multiple staff members throughout the department
- Insurance claims experience
9
Skills For Healthcare Contracting & Provider Relations Advocate Resume
- Dental experience (Dental Provider/Dentist Office/Dental Health Plan)
- Prioritize and meet deadlines from multi - staff members within the department
- Demonstrates the ability to use basic data analytics to solve problems
- Understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
- Understanding and comfort with working in complex data systems (such as Provider Express, Facets, Cosmos, etc.)
- Providing support to the WYhealth program to ensure that all contractual requirements are met
- Maintaining provider data bases
- Involved in identifying and remediating operational short-falls and researching and remediating claims
10
Skills For Provider Relations Advocate Resume
- Participate in identifying and remediating operational short-falls and researching and remediating claims
- Assist in identifying and remediating operational short-falls and researching and remediating claims
- Intermediate level of proficiency in claims processing (billing and coding) and issue resolution
- Provider Advocates in this role are the critical link to membership growth and new business development as well as building and maintaining PCP relationship
- Intermediate proficiency in Medicaid in claims research including end-to-end issue resolution
- Advanced proficiency in Medicaid claims processing and regulations
List of Typical Responsibilities For a Provider Relations Advocate Resume
1
Responsibilities For Dental Provider Relations Advocate Resume
- Support development and management of provider network
- Help implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
- Travel up to 25% regionally within Montgomery, Clark, Greene, Miami and Allen counties
- Intermediate level of proficiency with Microsoft Word and
- Travel within assigned region, up to 75-80%
- Intermediate proficiency with Medicaid and Medicare regulations
- Bi-lingual in English / Spanish
- Intermediate level of proficiency with Microsoft Word, Microsoft Excel, Microsoft PowerPoint, and Microsoft Access
- Travel up to 20% of the time within the State of California
2
Responsibilities For Healthcare Provider Relations Advocate Resume
- Willingness to travel 35%+ within the state of WY
- Facilitate provider meetings
- Travel regionally approximately 10%
- At least an intermediate level of proficiency with MS Office suite (Word, Excel, PowerPoint)
- Work with providers (Provider site or payor site)
- Basic Proficiency with MS Word, Excel, PowerPoint and Outlook
3
Responsibilities For Provider Relations Advocate Telecommute Resume
- Access to reliable transportation and ability to travel up to 75% within greater Dallas/Fort Worth area
- Established knowledge of local provider community
- Knowledge of dental products, providers, and/or clinical background
- Knowledge of Medicare and Medicaid reimbursement methodologies (i.e. Resource Based Relative Value System, APG, PPS, FFS, Capitation)
- Willingness to travel 35%+ within the state of WY and the designated region (Cheyenne)
- Proficiency with MS Word, Excel, PowerPoint, Outlook
- Travel regionally up to 75%, minimal overnights
4
Responsibilities For Senior Healthcare Provider Relations Advocate Resume
- ) of experience with Medicare and Medicaid regulations, including knowledge of payment guidelines and reimbursement methodologies such as DRGs, RUGs, etc
- Travel to providers 75% of the time
- Familiarity with the Minnesota market
- Demonstrated ability to utilize Microsoft Word to create general correspondence, update information within forms / templates, utilization of spell and grammar check
- Demonstrated ability utilizing Microsoft Excel to import data for reporting purposes, performing data entry, sorting /filtering, basic formulas and updating tables
- Proficiency with Medicaid and Medicare regulations
- Access to reliable transportation and ability to travel up 50% within greater Denver-Fort Collins area
- Travel locally to visit providers, up to 50% of the time
- Intermediate level of proficiency with MS Word, Excel,& PowerPoint
5
Responsibilities For Provider Relations Advocate / Network Manager Resume
- Familiarity with California state Medicaid programs
- Intermediate level of proficiency in claims research and issue resolution
- Familiarity with New Mexico state Medicaid programs
- Knowledge of Medicare and Medicaid reimbursement methodologies (i.e
- Resource Based Relative Value System, APG, PPS, FFS, Capitation)
- At least an intermediate proficiency with MS Office suite
- At least basic proficiency with MS Word, Excel, Outlook
6
Responsibilities For Senior Healthcare Provider Relations Advocate Telecommute Resume
- Travel locally up to 10%
- Comfort level with a fast-paced, high performance, autonomous role
- Able to commute daily to the Cypress, CA, office and willing to travel throughout Southern California for occasional daytime meetings with business partners and medical groups
- Travel approximately 25-40% within Washington, and reside within the Seattle/Tacoma area of Washington
- Travel approximately 50%, regionally within northern Ohio
- Travel up to 25% regionally
- Intermediate level of proficiency with MS Word, Excel, PowerPoint, and Access
7
Responsibilities For Ancillary Provider Relations Advocate Resume
- Travel on up to 50% of the time within the State of KS
- Targeted Provider recruitment
- Project management expereince
- Familiarity with WYhealth
- KS Medicaid
8
Responsibilities For Provider Relations Advocate Northeast Ohio Resume
- Travel approximately 50%, regionally within Southwest Ohio
- Travel on up to 25% of the time within the State of KS
- Live within a commutable distance to Overland Park, KS office
- MS Access and PowerPoint
- Proficiency with MS Access and PowerPoint
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