ALEXIS C. NUGENT
Seattle,WA
Summary
Experienced Medical Contract Specialist with 8 years of experience in contract administration and management. jack of all traits in the medical contracting space as well as detail-oriented in planning, managing procurement programs, and contracting activities.
Overview
8
8
years of professional experience
Work History
Provider Contract Specialist
Swedish Medical Group
11.2019 - Current
- Responsible for researching, analyzing, adding and amending provider healthcare contracts within Swedish Medical Group and Swedish Medical Center
- Ability to manage and support 100+ provider healthcare contracts in process at once within a fast-paced environment
- Strong attention to detail by reviewing healthcare provider contracts at Swedish Medical Group and Swedish Medical Center to ensure all language, metrics and compensation are accurate
- Responsible for contract lifestyle management including contract creation, contract extensions, contract execution/activation.
- Collaborated with cross-functional teams to develop comprehensive contract strategies that met business objectives.
- Strengthened internal controls by developing and implementing contract management policies, procedures, and templates.
Provider Inquiry Research and Resolution
Molina Healthcare
03.2019 - 11.2019
- Cross trained on Medicaid code edits and provider medical appeals within a month and a half
- Route denied edits to coding specialists to determine payment outcome and send provider resolution letters
- Determine claim denial (no prior auth, auth on file, eligibility confusion) and check member/prior auth history in QNXT
- Meet production goal of 40+ cases worked per day for code edit and medical appeals, 50 cases per day working from home.
Associate Provider Configuration Analyst
Molina Healthcare
11.2016 - 03.2019
- Responsible for researching and analyzing critical provider information
- Receive HICFA 1500 or UB04 facility claims via claims workflow and investigate why claims are pending
- Interpret and implement complex Fee For Service contracts
- Evaluate claims to determine if services, group/provider are being billed correctly
- Report miscellaneous data analysis findings to leadership within a timely matter
- Ability to juggle multiple projects at once by collaborating with various departments to maintain provider information and complete urgent requests as priority.
Education
BACHELOR OF ARTS IN GLOBAL STUDIES -
UNIVERSITY OF WASHINGTON
2013
Skills
- MediTract contract database
- Microsoft Office
- Onboarding Training
- Excel VLookup
- Project Management
- Needs assessments
- Documentation Review
- Contracting policies and regulations
- Dispute Resolution
Timeline
Provider Contract Specialist
Swedish Medical Group
11.2019 - Current
Provider Inquiry Research and Resolution
Molina Healthcare
03.2019 - 11.2019
Associate Provider Configuration Analyst
Molina Healthcare
11.2016 - 03.2019
BACHELOR OF ARTS IN GLOBAL STUDIES -
UNIVERSITY OF WASHINGTON
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