Senior Provider Relations Advocate Resume Sample
Karelle Kihn
4171 Kshlerin Ferry,
Los Angeles,
CA
+1 (555) 224 2288
Work Experience
Senior Provider Relations Advocate
07/2015
-
PRESENT
San Francisco, CA
- Bring the ‘voice of the provider’ to help shape outreaches being undertaken by UHG
- Travel within assigned market 3 days/week
- Understand how a providers office operates and understands their challenges
- Develops an intimate knowledge of the Providers’ practice
- Accountable for providing service and resolving issues
- Use pertinent data and facts to identify and solve a range of problems within are of expertise
- Travel to Provider locations in Long Island and / or downstate NY to achieve above goals
- Provider relations knowledge and understanding of community of care delivery systems throughout Northeast and Mid-Atlantic regions
Senior Provider Relations Advocate, UHN SE
10/2011
-
06/2015
New York, NY
- Manage face to face interactions with Providers
- Be able to act as a lead in the department; able to fill in for the Manager as needed
- Participate in Department / Company wide initiatives as Subject Matter Expert
- Assist in end - to - end provider claims and help enhance call quality
- Assist in efforts to enhance ease of use of physician portal and future services enhancements
- Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
- Help implement training and development of external providers through education programs
- Assist in end-to-end provider claims and help enhance call quality
Senior Provider Relations Advocate Telecommute
04/2007
-
09/2011
New York, NY
- Identify gaps in network composition and services to assist network contracting and development teams
- Directly responsible for working with IPA physicians to ensure provider satisfaction in accordance with the IPA standards
- Directly responsible for working with the designated health plan representatives on local issues and concerns (including directory accuracy)
- Directly responsible for all physician education including distribution of key IPA documentation and policies and procedures and orientations
- Directly responsible for education of physician’s management staff and performs regularly scheduled Office Manager’s meetings
- Responsible for ensuring network compliance with regulatory requirements including but not limited to accessibility and availability of required specialties
- Responsible for understanding local market dynamics performing routine market analysis and organizing appropriate marketing and promotional activities
- Responsible for ensuring network is maximized based on market analysis and that there are no network gaps, including identification of new providers
- Responsible for optimizing electronic connectivity between the providers and NAMM operations to ensure economical transaction management
Education
Columbia International University
2003 - 2007
Bachelor's Degree in Communication
Professional Skills
- Strong organizational and communication skills. Adept at problem solving
- Excellent written and verbal language skills
- Professional verbal and written communication skills including typing, with the ability to develop correspondence to facilities and clinicians
- Good organization, planning skills
- Exceptional interpersonal and relationship skills
- Exceptional presentation, written, and verbal communication skills
- Work independently, organizing and prioritizing work flow
How to write Senior Provider Relations Advocate Resume
Senior Provider Relations Advocate role is responsible for insurance, design, reporting, planning, training, travel, health, transportation, analytical, education.
To write great resume for senior provider relations advocate job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Senior Provider Relations Advocate Resume
The section contact information is important in your senior 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 Senior Provider Relations Advocate Resume
The section work experience is an essential part of your senior 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 senior 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 senior 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 Senior Provider Relations Advocate resume experience can include:
- Provider relations, contracting, and / or provider network experience
- Experience in claims processing / issue resolution
- Proficient at managing multiple tasks and priorities
- Experience working with UHG Claim and Provider Systems (NDB, Facets, etc.)
- Experience working with UHG Claim and Provider Systems (NDB, COSMOS, Facets, etc.)
- Experience in a network management-related role within the California market, such as contracting or provider services
Education on a Senior Provider Relations Advocate Resume
Make sure to make education a priority on your senior 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 senior 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 Senior Provider Relations Advocate Resume
When listing skills on your senior 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 senior provider relations advocate skills:
- Effectively present information and respond to questions from physicians, clients, customers and the general public
- Experience in providing training or education
- Related experience in resolving escalated and/or challenging customer service issues(i.e. senior customer service based roles)
- Experience in an outward facing role
- Experience in claims processing or claim issue resolution
- Provider relations and / or provider network experience, including provider presentations
List of Typical Experience For a Senior Provider Relations Advocate Resume
1
Experience For Senior Provider Relations Advocate, UHN SE Resume
- Experience with claims issue resolution
- Experience with Medicaid
- Responsible for working with IPA physicians to ensure provider satisfaction in accordance with the IPA standards
- Manage provider contracts deemed appropriate by the Executive Director
- Involved with efforts to enhance ease of use of physician portal and future services enhancements
- Travel as necessary to build Provider relationships with our Medical Groups
- Designs and implements programs to build and nurture positive relationships between the health plan, providers and practice managers
2
Experience For Senior Provider Relations Advocate, Hospital Resume
- Contribute to design and implementation of programs that build / nurture positive relationships between the health plan, providers and practice managers
- Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers, and practice managers
- Initiate and lead contract negotiations with critical behavioral health physician groups
- Strategic provider recruitment and network development; Ensure that network composition includes an appropriate distribution of provider specialties
- Responsible for relationships with key customers in the market in relation to all network management activities and initiatives
- Act as primary contact for escalated internal and external customer issues
3
Experience For Senior Provider Relations Advocate Telecommute Resume
- Identify methods and formats for providing education/training, including communications, live presentations, and information provided over the Internet; Coordinate presentations with all departments, as requested
- Conduct and/or participate in special projects, as directed
- Supervise, coach, provide feedback, and guide others
- Responsible for working the designated health plan representatives on local issues and concerns and coordinate with contracts representative for directory accuracy
- Responsible for all physician education including distribution of key IPA documentation and policies and procedures and orientations
- Responsible for education of physician’s management staff and performs regularly scheduled Office Manager’s meetings
4
Experience For Senior Provider Relations Advocate Resume
- Review, prepare and distribute Provider Capitation Packets monthly to meet provider contractual requirements
- Recruit providers for the expansion of the Medicaid network for the state
- Work with providers in the North Dakota market in the role of Senior Advocate
- Conduct frequent, in-person focus visits with providers within assigned geographic region
- Assist in out of network recruitment and support other geographic areas as needed
- Travel to Provider locations in Long Island and 5 boroughs of NY City to achieve above goals
- Work independently and remain on task with little to no day to day supervision
5
Experience For Senior Provider Relations Advocate, UHN SE Resume
- Proficiency with MS Word, Excel, PowerPoint and Access
- At least an intermediate level of proficiency with MS Excel, Word, and PowerPoint
- Reside in Sacramento Bay Area and ability to travel regionally about 25%
- At least an intermediate proficiency with MS Office, particularly PowerPoint and Excel
- Travel local to Western PA for provider visits
- Knowledge of the Western PA market
6
Experience For Senior Provider Relations Advocate, Hospital Resume
- Intermediate proficiency with MS Office, particularly PowerPoint and Excel
- Intermediate level of proficiency in claims issue resolution
- Present to large groups (50-200 audience members)
- Travel – Statewide of New Mexico
- CSP Facets claims platform knowledge
- AuthentiCare and/or electronic visit verification system
- Proficiency with MS Word, Excel, PowerPoint, and Access
7
Experience For Senior Provider Relations Advocate Telecommute Resume
- Knowledge of the Iowa provider community
- Residence in the state of Louisiana
- Proven experience supporting, developing and maintaining service relationships with key network personnel including, but not limited to, physicians, providers and provider office staff
- At least an intermediate proficiency with MS Word, Excel and PowerPoint
- Up to 50% local travel to Western PA for provider visits required
- Travel on occasion, locally within the state of Kansas
8
Experience For Senior Provider Relations Advocate Resume
- Up to 50% local travel to Eastern PA for provider visits required
- Knowledge of the EasternPA market
- Up to 50% local travel to Central PA for provider visits required
- Knowledge of the Central PA market
- Proficiency of MS Outlook (send calendar invites, send WebEx meetings, etc.)
- Travel up to 50% of the time within the State of KS
9
Experience For Senior Provider Relations Advocate, UHN SE Resume
- Intermediate level knowledge MS Word, Excel, PowerPoint
- Knowledge of Medicaid Regulations
- In Provider Relations role
- Travel to Long Island and 5 boroughs of NY City 75%
List of Typical Skills For a Senior Provider Relations Advocate Resume
1
Skills For Senior Provider Relations Advocate, UHN SE Resume
- Experience working with Medical Providers
- Experience with Medicare and Medicaid regulations
- Experience with CSP Facets, Cosmos, NDB, UNET
- Experience with Risk Adjustment
- Experience with Medicare or Medicaid regulations
- Experience with Access, NDB, Nice, Pulse, Iset, Unet, Cosmos, Impact, and / or IBAAG
- Network development experience
- Experience with UHG Claim Platforms (COSMOS, FACETS, etc.)
2
Skills For Senior Provider Relations Advocate, Hospital Resume
- Provider relations and / or provider network experience
- Provider or client relations experience
- Experience with either Medicare or Medicaid regulations
- Health care / managed care experience
- 1+ of years experience with Medicare and Medicaid regulations
- Health care/managed care experience
- Experience with NDB, ISET and Facets
3
Skills For Senior Provider Relations Advocate Telecommute Resume
- Previous work experience with providers in North Carolina
- Experience in the healthcare and / or health insurance industries
- Experience in a provider relations and / or provider network role
- Provider relations and/or provider network experience (ancillary and/or hospital)
- Intermediate level experience with MS Word and Excel
4
Skills For Senior Provider Relations Advocate Resume
- Experience with MS PowerPoint and Access
- Prioritize and meet deadlines from multiple staff members within the department
- Health care / managed care experience
- Health care/managed care experience
- Experience with UHG systems NDB, UNET, COSMOS, FACETS, PhyCon, Emptoris
- Experience with Medicare and Medicaid plans and regulations
- Experience with providers within the state of Virginia
- Presentation experience
- Experience with providers within the state of Maryland
5
Skills For Senior Provider Relations Advocate, UHN SE Resume
- Provider relations and/or provider network experience
- Experience with Medicaid regulations
- Experience with providers within the state of Alabama
- Experience with Medicare and medical regulations
- Experience with CSP Facets and/or ISET
6
Skills For Senior Provider Relations Advocate, Hospital Resume
- Experience with providers within the state of Louisiana
- Health care experience, preferably in managed care
- Previous experience with CSP Facets
- Provider relations and/or provider network experience
- Experience with Medicaid
- Experience with Kansas Medicaid
7
Skills For Senior Provider Relations Advocate Telecommute Resume
- Prioritize and meet deadlines from multi- staff members within the department
- Prioritize and meet deadlines from multi staff members through the department
- Provider Recruitment experience
- Experience with FQHC's
- Working knowledge of ICD-9, CPT and HCPCS coding
- Working knowledge of NDB, Iset, Impact, Cosmos, and Facet
- Facilitating Internal/External Meetings
- Familiarity with reviewing, interpreting and utilizing data files
8
Skills For Senior Provider Relations Advocate Resume
- Assist in identifying gaps in network composition and services to support network contracting and development teams
- Intermediate level of Proficiency with MS Office including MS Excel
- Health care marketing/provider
- Access to reliable transportation and ability to travel 50% within Chino Hills and surrounding area
- Advanced level of proficiency in claims processing and issue resolution
9
Skills For Senior Provider Relations Advocate, UHN SE Resume
- Assist in end-to-end provider claims processing and resolution
- Help implement training and development through education programs
- Actively contribute and work on key department initiatives such as recontracting providers
- Help implement training and development of external providers through education program
- Intermediate level of proficiency with MS Word and MS Excel
10
Skills For Senior Provider Relations Advocate, Hospital Resume
- Analyze reports to make sound recommendations
- Intermediate use of MS Word, Excel and PowerPoint
- Intermediate level of proficiency with MS Word, Excel & PowerPoint
- Live within the vicinity of Southern New Mexico
- Able to construct and interpret contract language/terms
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