Tara Floyd
Eagle Springs,NC
Summary
Experienced Provider Relations Coordinator with solid background in managing and improving healthcare provider relationships. Strengths include effective communication, problem-solving, and project management skills. Previous work demonstrates successful coordination of services between providers and patients, improved efficiency in resolving claims issues, and contribution to enhancing overall patient satisfaction.
Overview
8
8
years of professional experience
Work History
Provider Relations Coordinator
FirstCarolinaCare
Southern Pines, NC
07.2023 - Current
- Responsible for assisting healthcare providers and clients with the resolution of issues related to claims and provider participation questions.
- Role includes maintaining provider database to ensure Provider Directory and claim processing information is complete and accurate.
- May also assist in the resolution of denied claims accurately to ensure proper reimbursement to providers.
- Assist FCC claims team in identifying issues to resolve claims denials to prevent future denials.
- Identifies needs of providers and their staff and coordinates with additional departments as necessary to provide appropriate support and initiate improvement opportunities.
- Develops communications, education materials, conducts and/or participates in education programs for providers and their staff.
- Initiating and maintaining effective channels of communication with providers and clients.
- Assist in the resolution of provider and/or member complaints related to billing / claims issues.
- Gather, review, and verifying all pertinent information relating to participating providers to ensure proper claims processing.
Secretary II
Pinehurst Surgical Clinic P.A.
Pinehurst, NC
07.2017 - 07.2023
- Responsible for performing clerical tasks to ensure efficient department flow.
- Provide clinical support to providers and other clinical staff.
- Register new patients and schedule appts.
- Complete pre-certifications for patient visits prior to appts.
- Reviewed provider claims for accuracy prior to submitting them for payment processing.
- Enter demographic and correct insurance information.
- Process incoming referrals based on dept policy.
- Assure patient insurance carriers are contracted and verify insurance benefits to ensure correct copays or coinsurances are collected.
- Complete insurance authorizations for Physical Therapy visits.
- Track Medicare Cap allowable for Physical Therapy.
Education
Certificate - Surgical Technology
Sandhills Community College
Pinehurst, NCSkills
- Educational presentations
- Problem-solving aptitude
- Multitasking Abilities /Task prioritization
- Team leadership
- Customer service
- Organizational skills
- Experience in PowerPoint
- Insurance claims billing
- Detail-oriented
- Communication skills
Timeline
Provider Relations Coordinator
FirstCarolinaCare
07.2023 - Current
Secretary II
Pinehurst Surgical Clinic P.A.
07.2017 - 07.2023
Certificate - Surgical Technology
Sandhills Community College
Similar Profiles
Petrina RussellPetrina Russell
Manager of Medicare & Regulatory Compliance at FirstCarolinaCare Insurance CompanyManager of Medicare & Regulatory Compliance at FirstCarolinaCare Insurance Company
Mollie EdwardsMollie Edwards
Provider Relations Coordinator at FirstCarolinaCare Insurance Co.Provider Relations Coordinator at FirstCarolinaCare Insurance Co.
Melanie GandinoMelanie Gandino
Lead Sales Associate at Dollar General StoreLead Sales Associate at Dollar General Store