Amber Meador
Molina Healthcare of Iowa
Winterset
8
years of professional experience
Healthcare Operations professional with 7+ years of experience in provider relations and Medicaid managed care. Specializes in resolving complex claims issues, enhancing provider experiences, and coordinating statewide solutions. Demonstrates expertise in compliance, operational training, and cross-agency collaboration, with a strong background in multi-county territory management.
Work History
Senior Representative, Provider Services
2 Years 8 Months- Acted as primary liaison for providers across Henry County, Jefferson County, and southeastern Iowa, including Great River Health, Jefferson County Health Center, Vera French, and intermittent support for chiropractic providers.
- Delivered onboarding, operational training, and workflow guidance to physicians, executives, clinic managers, behavioral health teams, and specialty practices, enhancing provider integration and service delivery.
- Resolved escalated contract, billing, and claims issues by coordinating with Claims, Configuration, Credentialing, Compliance, and Quality teams.
- Identified root causes of recurring payment and configuration issues and implemented long-term corrective actions.
- Audited provider directories for compliance and accuracy, reducing member access errors and improving regulatory alignment.
- Identified root causes of recurring payment and configuration issues, implementing long-term corrective actions that improved claims resolution processes.
- Mentored new Provider Services representatives, fostering statewide operational consistency and ensuring quality service delivery.
- Position ended due to company-wide layoffs effective 7/1/2026.
Provider Services Representative
6 Months- Managed provider relationships and conducted on-site education visits to enhance service delivery across assigned territories.
- Maintained provider demographic and panel information, ensuring accurate claims routing and facilitating member access.
- Investigated billing delays and coordinated cross-functional resolutions to enhance provider satisfaction.
Claims Research Specialist
2 Years 8 Months- Investigated complex payment issues, collaborating with configuration and IT teams to resolve systemic errors and improve payment accuracy.
- Processed state configuration updates, ensuring compliance with regulatory requirements and minimizing potential legal risks.
- Performed claims audits, documenting findings and managing the state information letter repository to support regulatory adherence.
Claims Liaison
1 Year 5 Months- Audited weekly claims payment cycles to identify discrepancies, preventing downstream errors.
- Coordinated manual claim corrections and collaborated with leadership to streamline claims workflows.
- Supported providers with claims education and resolved issues to enhance provider satisfaction.
Medicaid MCO Biller
9 Months- Processed Medicaid managed care claims, resolving coding discrepancies and denials to ensure timely reimbursements.
- Collaborated with clinical and billing teams to verify documentation accuracy, facilitating prompt reimbursement.
- Processed and submitted patient billing claims to ensure timely reimbursement.
- Reviewed and corrected discrepancies in patient accounts for accuracy.
- Collaborated with healthcare providers to obtain necessary documentation for billing.
Education
High School Diploma
Skills
Provider Relations
Claims Resolution
Medicaid & Medicare
Provider Education
Compliance
Network Support
Root-Cause Analysis
Process Improvement
Cross-Functional Collaboration
Data Analysis
Claims Management
Claims Processing
Relationship management
Client engagement
Interdepartmental Collaboration
Provider Engagement
Data Management
Timeline
Senior Representative, Provider Services
Molina Healthcare of Iowa
11.2023 - 07.2026Read More
Provider Services Representative
Molina Healthcare of Iowa
05.2023 - 11.2023Read More
Claims Research Specialist
Iowa Total Care
09.2020 - 05.2023Read More
Claims Liaison
Iowa Total Care
04.2019 - 09.2020Read More
Medicaid MCO Biller
Adair County Memorial Hospital
05.2018 - 02.2019Read More
Winterset Senior High School
High School Diploma
Read More