Cara Waetjen
Prineville,OR
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
17
17
years of professional experience
Work History
PPO & Direct Contract Coordinator
Shasta Administrative Services
Redmond, OR
03.2007 - Current
- Experience with network pricing for First Choice Health Network, Aetna and Cigna, including reviewing pricing to ensure accuracy and using Network based pricing tools to confirm accuracy.
- Responsible for building, maintaining and verify existing Networks within the claims management system, Javelina, including Connection Dental, Cigna and established direct contracts including both open and single case agreements to ensure claims move through the auto-adjudication process in a timely manner with accurate pricing.
- Work specific queues in the Javlina system for either PPO or Provider Maintenance issues.
- Maitain and update provider and 1099 records as needed.
- Direct Contracting, starting with negotiating rates with providers, to ensuring contracts are signed in a timely manner by both parties, and finishing with setting up contract in Javlina. Add amendments as needed.
- Help with Client Billing once a month, including running Clinet invoices, a census to ensure member numbers on the client invoice is accurate, creating all vendor invoices related to the Clients billing.
- Accounts Payables, keying in and paying invoices for both Client vendors and business related expenses twice a week.
- Help maintain Critical Access Hospital rates, including updating and maintaining a spreadsheet of Critical Acces Hospitals and their rates, opening a ticket with Payer Compass to have rates updated.
- Certified Notary in the state of Oregon, notarizing company documents such as state licenses and financial statememts
- Claims processing, including group specific claims, Medicaid Reimbursement claims and Mental Health/Substance Abuse claims.
Education
High School Diploma -
Crook County High School
Prineville, OR06-1991
Skills
- Contract Negotiation
- Self-motivated
- Works well with others
- Able to work on my own with little or no direction
- Willing to take on new duties or projects
- Multi-tasking
- Knowledgeable in Tribal Insurance
- Professional relationship building
References
References available upon request.
Timeline
PPO & Direct Contract Coordinator
Shasta Administrative Services
03.2007 - Current
High School Diploma -
Crook County High School
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