Aziza Mbuyamba, MBA
Dallas
Summary
Business Operations and Development expert with years of experience in healthcare provider operations. Demonstrates a comprehensive understanding in provider relations , provider contracting , credentialing, claims and strategic business healthcare markets. In-depth knowledge of CMS policies and regulations, while leveraging personal skills in Salesforce, data management, and project management to drive stakeholder engagement and operational efficiency. Passionate about implementing innovative solutions to enhance provider operations and improve service delivery.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Network Manager II
Shared Health ( Contract)
04.2024 - 04.2025
- Introduced Shared Health program to new territory, while developing and expanding health care provider networks
- Act as a single point of contact to field and resolve health care providers issues regarding fee schedules, claims, credentialing, referral simplification, patient population confirmations and other ad hoc network projects
- Built contracts using healthcare market intelligence and negotiations to fit company and health care
- Implemented an automated tracking system for over 100 health care providers inquiries reducing retrieval times and provider satisfaction
- Monitored adequacy and production in assigned territory while working with key stakeholders to develop and maintain strategies that address deficiencies. Facilitated workshops with stakeholders to identify process inefficiencies, leading to streamlined operations and improved service delivery.
Network Management Consultant
Blue Cross Blue Shield TX
05.2021 - 04.2024
- Performed problem-solving issues for highly complex provider accounts that included but not limited to the following: global claim issues, provider configurations, authorizations, care management, credentialing, and enrollment assignments
- Recruiting and maintenance of provider networks to ensure adequate coverage for all products
- Conducted in-depth provider evaluations of contractual performance, leading to improved compliance and strategic amendments that optimized provider relationships.
- Conducted provider training and guidance on system usage, document fillings and state regulation updates.
- Worked closely with internal teams to align provider network objectives, fostering a unified approach to service delivery.
Sr. Provider Relations Rep
University Health Systems (CFHP)
08.2018 - 05.2021
- Managed over 50 assigned LTSS providers and facilities within territory; ensuring networks adequacy for each line of business by recruiting and contracting new providers
- Resolved provider claim, COB's and authorization inquiries within timely manner
- Facilitated stakeholder education on company systems portals and policies
- Participated in required Texas Medicaid Healthcare partnership and community events to lecture on resources provided by organization
- Conducted educational sessions for providers, fostering understanding of company policies and improving engagement.
- Monitored provider data accuracy in QNXT, ensuring compliance with CMS standards and enhancing reporting efficiency.
- Engaged in community events to promote organizational resources, increasing awareness and utilization among stakeholders.
- Updated provider manuals and websites as per CMS requirements, improving access to critical information for stakeholders.
Provider Relations Rep
Cigna Health Spring’s
10.2015 - 07.2018
- Resolved claim issues, enhancing provider relationships and improving service efficiency.
- Educated providers on policies, boosting compliance and satisfaction.
- Facilitated healthcare record retrieval, supporting HEDIS project success.
- Conducted user acceptance testing' configuration changes through QNXT for new provider contracts ensuring system reliability and accuracy.
- Assisted case managers with member grievances processing and claims reconsideration improving member satisfaction and retention.
Education
Master's - Business Administration
King University
Bristol, VA05.2017
Bachelor's - Social Work
Austin Peay State University
Clarksville, TN05.2014
Skills
- Healthcare Operations
- Provider Relations
- Recruiting
- Contracting
- Credentialing
- Project Management
- Account Management
- Microsoft Office
- Business Analytics
- Client Relations
- Data Management
- Retention
- Salesforce
- Business Operations
- Risk Management
- Claims
Certification
Data Analyst- June 2020
Brain Station
Languages
French
Native or Bilingual
German
Full Professional
Lingala
Native or Bilingual
Timeline
Network Manager II
Shared Health ( Contract)
04.2024 - 04.2025
Network Management Consultant
Blue Cross Blue Shield TX
05.2021 - 04.2024
Sr. Provider Relations Rep
University Health Systems (CFHP)
08.2018 - 05.2021
Provider Relations Rep
Cigna Health Spring’s
10.2015 - 07.2018
Bachelor's - Social Work
Austin Peay State University
Master's - Business Administration
King University
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