Ashton Snyder Maxwell
Marysville,PA
Summary
A business professional experienced in Healthcare Administration, Healthcare Project Management, Business Development, with an innate ability to build and maintain relationships. An articulate communicator, skilled in gathering, analyzing and translating business requirements into sophisticated strategies with the talent to influence the key stakeholders while delivering outstanding client service in competitive markets.
Skills Summary
• Managed Care: Medicare, Medicaid, Marketplace
• Relationship Management
• Training & Education
• Business & Network Development
• Quality & Performance Management
• Project Management
• Process Improvements
• Business Analysis
• Cross functional Collaboration
Dynamic professional with a proven track record at Centene, adept in enhancing provider engagement and network administration. Excelled in employee training and relationship development, significantly improving network performance and provider satisfaction. Skilled in project coordination and continuous improvement, leveraging analytical prowess to drive strategic initiatives. Achieved notable success in optimizing processes and fostering cross-functional collaboration for superior service delivery.
Overview
9
9
years of professional experience
Work History
Provider Engagement Administrator II
Centene
02.2022 - Current
- Manages Network performance for assigned territory through a consultative/account management approach
- Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, et
- Evaluates provider performance and develops strategic plan to improve performance
- Performs detailed HBR analysis
- Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Triages provider issues as needed for resolution to internal partners
- Receive and effectively respond to external provider related issues
- Investigate, resolve and communicate provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
- Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
- Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
- Coaches new and less experienced External Reps
- Completes special projects as assigned
- Maintained personnel records and updated internal databases to support document management.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Cultivated positive, trusting relationships with clients and community providers to promote effective coordination of resources.
- Developed and maintained strong relationships with large health systems and billing parties to maintain loyalty and satisfaction.
- Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
- Met with community providers to foster good rapport and relationships and identify new programs.
- Built professional relationships with service providers.
- Managed internal and external client-facing relationships through transitional periods.
- Established and maintained business relationships with CEOs, Finance VPs and other senior leaders.
- Answered provider inquiries via email, telephone and written correspondence.
- Established and maintained working relationships with various internal groups to create comprehensive, well-designed sustainable set of key deliverables for clients.
- Developed and maintained productive working relationships with healthcare providers.
- Networked with industry professionals to exchange best practice knowledge and stay abreast of latest developments.
- Generated reports detailing findings and recommendations.
- Cultivated positive relationships with provider and large health systems to increase health plan initiative success and quality outcomes.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
- Educated providers on payer orientations and systems and overall goals to help providers achieve success.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Evaluated provider needs and feedback to drive product and service improvements.
- Developed effective improvement plans in alignment with goals and specifications.
- Devised and implemented processes and procedures to streamline operations.
Provider Engagement Administrator I
Centene
08.2019 - 02.2022
- Perform duties to act as a liaison between providers, the health plan and Corporate.
- Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Conduct monthly face-to-face and virtual meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution.
- Receive and effectively respond to external provider related issues
- Provide education on health plan’s innovative contracting strategies
- Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
- Investigate, resolve and communicate provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
Insurance Referral and Authorization Specialist II
UPMC Pinnacle
05.2015 - 08.2019
- Responsible for the coordination of the referral process within UPMC Pinnacle Health Medical Group.
- Responsible for coordinating specialty referrals and diagnostic authorizations and testing for the UPMC Pinnacle Health sites and outside facilities.
- Pre-certifies diagnostic testing, as required by patient's insurance. Educates the patients on various policies, procedures, and benefits, related to the need for referrals and authorizations.
- Works closely with insurance companies, identifying, verifying, and applying insurance coverage for patients.
- Coordinates referrals and authorizations with patients and specialist's offices, and processes insurance referrals as required.
- Acts as a liaison between patient, physician, specialist, and insurance company.
- Handles multi-line phones, telephone calls, messages, and communicates with other members of medical team regarding patient care. Including faxing, filing, and typing, sending business correspondence.
- Updates confidential client information files, scanned documents into patient charts, and managed files as needed.
- Obtained, released and scanned medical
records. - Communicates with supervisors and peers about documenting and recording patient files and otherwise obtaining information from other medical facilities.
- Resolves conflicts, settled disputes and insured patient satisfaction.
- Ensures accurate data entry and completion of
authorization from referral/authorization forms, medical documentation. - Contacts providers to obtain missing medical documentation to assure compliance with timelines.
- Efficiently uses Epic (Electronic Medical Record software) to assist physicians and patients in various aspects.
- On-boarding mentor and trainer for new staff. Oversees training for new hires within the department and handles IT issues.
- Developed training guidelines and procedures for the UPMC PHMG Referral Departments in Harrisburg, Lancaster, York, Carlisle, and Hanover
Education
High School Diploma -
Susquenita High School
Duncannon, PANo Degree - General Studies
Millersville University of Pennsylvania
Millersville, PABachelor of Science - Healthcare Administration
New England College
Henniker, NHMaster of Science - MHA in Progress
University of Phoenix
Tempe, AZSkills
- Expense Monitoring
- Schedule Coordination
- Travel Coordination
- Technical Documentation
- Project Coordination
- Program Oversight
- Customer Service
- Information Management
- Office Administration
- Executive Support
- Business Development
- Work Planning and Prioritization
- Scheduling
- Personable and Approachable
- Attention to Detail
- Performance Improvement
- Administrative Support
- Resourceful and Analytical
- Multi-Line Phone Systems
- Expense Reporting
- Program Management
- Multiple Priorities Management
- Meeting facilitation
- Document Management
Timeline
Provider Engagement Administrator II
Centene
02.2022 - Current
Provider Engagement Administrator I
Centene
08.2019 - 02.2022
Insurance Referral and Authorization Specialist II
UPMC Pinnacle
05.2015 - 08.2019
High School Diploma -
Susquenita High School
No Degree - General Studies
Millersville University of Pennsylvania
Bachelor of Science - Healthcare Administration
New England College
Master of Science - MHA in Progress
University of Phoenix