DEANDREA SMITH
United Healthcare
Houston,TX
15
years of professional experience
Motivated team player, bringing over 15 years of healthcare experience, seeking a challenging and responsible position within an organization that provides an environment for professional growth and development. Goal-oriented individual with a pleasant personality and a tenacity that knows no restrictions.
Work History
Contract Manager
3 Years 4 Months- Contract Manager for Hospital and Ancillary Facilities - Pricing Configuration and Rate Loading
- Evaluate contracts in compliance with company templates, reimbursement structure standards, and other key process controls.
- Resolve contract-related issues and disputes in a timely manner.
- Manage the complete contract lifecycle; including contract creation, approval, execution, amendments, renewals, and termination.
- Ensure contracts and supporting documentation meet internal standards, audit requirements, and retention rules.
- Support audits by ensuring complete and accurate contract documentation.
- Configure Commercial, Medicare, Medicaid, and value-based reimbursement models as applicable.
- Load and maintain provider contract rates, reimbursement schedules, and benefit pricing according to executed contracts.
- Perform rate loading for new provider contracts, amendments, renewals, and reimbursement updates.
Provider Relations Advocate
3 Years 11 Months- Served as the Provider Relations Advocate handling the State Complaints submitted to Texas Health and Human Services.
- Receive, review, investigate, and process provider appeals, grievances, and complaints.
- Maintain accurate documentation of all case activities within case management systems.
- Answered Provider inquiries via Email within the Regional Team.
- Monthly Check Ins with Assigned Providers in Southeast Region.
- Respond to provider inquiries regarding claim, eligibility, authorizations, billing, reimbursement contracts, and operational processes.
- Conduct regular site visits to ensure compliance with HIPAA, state regulations, and organizational policies.
- Served as a subject matter expert for provider contracting and maintains contracts with contract management.
- Support provider onboarding, credentialing, demographic updates, and assist with regulatory audits.
Clinical Administrator Coordinator
4 Years 7 Months- Worked with hospitals, clinics, facilities and the clinical team to manage requests for services from providers via phone, fax, and/or provider portal.
- Processed incoming and outgoing referrals and prior authorizations, including intake, notification and census roles.
- Assisted the clinical staff with setting up documents/triage cases for clinical review.
- Handled resolutions and inquiries from members and providers regarding authorizations.
- Coordinate communication between physicians, nurses, laboratories, pharmacies, and external providers.
- Monitor work queues and clinical requests to ensure timely follow-up.
- Maintain accurate electronic health records (EHR) and ensure documentation is complete and compliant.
Provider Service Representative
3 Years 2 Months- Research and resolve provider inquiries in a timely and accurate manner.
- Assisted providers with claim status, payment inquiries, appeals, and claim adjustments.
- Coordinate with Claims, Providers Relations, Credentialing, Medical Management, and Customer Service teams to resolve complex issues.
- Educate providers on health plan policies, procedures, billing guidelines, and reimbursement practices.
- Support provider enrollment, credentialing, contracting, and demographic updates.
- Identify trends and recurring provider issues and escalate concerns as appropriate.
- Maintain knowledge of healthcare regulations, payer policies, and organizational procedures.
Education
High School Diploma
Skills
Microsoft Office Suite
Data entry-10-Key
Client Relations
HIPAA Compliance
Knowledge of Commercial
Medicare and Medicaid Products
Self-motivated
Exceptional Quality Checking
Conflict resolution
Data management
Strong verbal communication
Compliance in regulated environments
Training
Peoplesoft
Problem solving
Troubleshooting
Claims processing
Data entry
Interpreting and analyzing data
Typing Speed: 60-65 wpm
10-key
Database Software
Office Equipment
Email Software
ACD (Cisco) Avaya
AS/400(iSeries)
Prescription Solutions
CRM
Skype
Diamond Suite Software
ICD-9 Coding
Facets
EPIC
NDB
ISETS
COSMOS
ICUE
PHYCON
Contract Management
Project Management
Microsoft EXCEL
CLM
Salesforce
EHR
Medical Records Management
Provider Relations
Healthcare Operations
Timeline
Contract Manager
United Healthcare
01.2023 - 05.2026Read More
Provider Relations Advocate
United Healthcare
02.2019 - 01.2023Read More
Clinical Administrator Coordinator
United Healthcare
07.2014 - 02.2019Read More
Provider Service Representative
United Healthcare
05.2011 - 07.2014Read More
Cypress Falls High School
High School Diploma
Read More