Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic
Carla Dever

Carla Dever

Greenville,TX

Summary

Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions. To obtain a position within a company where I can utilize my knowledge and skills training future employees, while participating in new experiences; a management position that will continually help me enhance my professional and personal growth.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Provider Install Specialist

United Health Care
06.2022 - Current
  • (Non-Delegated, Delegated, NRMM, & WellMed, CSP, NICE, and Pulse Trained)
  • Load contract information or implement updates and amendments (e.g., fee schedule updates, new fee schedules, demographic changes, termination, rate corrections) accurately into appropriate systems (e.g., NDB, COSMOS, FACETS, PPO-One, NICE, PULSE)
  • Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading (e.g., turnaround time, number of contracts loaded, accuracy) to assess performance, determine potential issues, and/or prioritize workloads (e.g., submissions to be addressed first)
  • Receive and/or make determination regarding provider and/or contract changes or amendments (e.g., termination, product ads, revenue code changes, level of care
  • Collaborate with relevant internal and/or external partners (e.g., IT, CMS, Ingenix, vendors) to ensure that data is timely and accurate.
  • Communicate identified discrepancies back to contract submitter to facilitate corrections of discrepancies.

Sr. Provider Data Specialist

United Health Care
04.2019 - 06.2022
  • (Non-Delegated, Delegated, NRMM, NICE, CLM & WellMed Trained)
  • Database maintenance, reporting and extracting data for various reports and analyses as well as initiating database.
  • Provide input/suggestions into database or system design based on process, information, or regulation changes, or client requirements.
  • Utilize database systems and tools to enter and/or research provider data (e.g., Excel; FACETS; NDB; Serena Team Track; NICE; COSMOS, Convey)
  • Receive the data from multiple inbound sources (e.g., spreadsheets, email, claim)
  • Responsible for representing the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles.

Provider Data Specialist

United Health Care
04.2017 - 04.2019
  • (Non-Delegated)
  • Database maintenance, reporting and extracting data for various reports and analyses as well as initiating database.
  • Develop’s and mountain’s standards for database integrity and quality assurance, coordinate’s corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements.
  • Conduct’s audits and provider’s feedback to reduce errors and improve processes and performance.
  • Responsible for representing the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles.

Front Office Representative/Supervisor

Embassy Suites
12.2016 - 10.2018
  • Preformed bookkeeping activates, such as account payable, accounts receivables and nightly audit.
  • Assisted guests with geographical knowledge of local area I.E., entertainment, fine dining and shopping.
  • Provided hospitable service to guest and potential guests
  • While implementing high-impact sales and marketing initiatives resulting in increased occupancy and profitability.

Education

Carroll High School
05.2008

Skills

  • Knowledge of Microsoft office: Excel, (hyperlink, pivot tables, macro) PowerPoint, Word (50wpm), Outlook, Share Point, BUI
  • Knowledge of Cisco Software, HRIS software, Nelnet, Big Brother, Kronos Aerial, Payroll, HIPPA Law, Lotus Notes, Aerial, IBM Personal Communicator, NDB, ProBase, CSP, Pulse & Nice
  • Excellent verbal and written communication skills

Certification

  • Certified Adult First Aid | CPR AED, EMS SAFETY HSI 7/22/2023-7/2025

Languages

AMERICAN SIGN LANGUAGE
Limited Working

Timeline

Provider Install Specialist

United Health Care
06.2022 - Current

Sr. Provider Data Specialist

United Health Care
04.2019 - 06.2022

Provider Data Specialist

United Health Care
04.2017 - 04.2019

Front Office Representative/Supervisor

Embassy Suites
12.2016 - 10.2018

Carroll High School

Similar Profiles

CREATE PROFILE
Carla Dever