Catherine Swinger
Atlanta,GA
Summary
Network Account Manager with a proven track record at Zelis and HCA, excelling in client relationship management and contract negotiation. Achieved consistent client satisfaction through proactive problem-solving and strong teamwork skills. Expert in analyzing trends to drive network growth and adept at multitasking to meet rigorous targets. Highly motivated Account Manager adept at building strong relationships with customers, understanding their needs, and providing tailored solutions. Possesses excellent communication, interpersonal, and problem-solving skills. Resourceful Account Manager with excellent client oversight, issue resolution and relationship-building expertise. Maximized repeat business opportunities and utilized proven prospecting techniques to expand client base. High-level sales cycle knowledge and strong collaborative skills leading to optimum outcomes.
Overview
23
23
years of professional experience
Work History
NETWORK ACCOUNT MANAGER
Zelis
04.2012 - 11.2023
- Developed and maintained relationships with key accounts to ensure customer satisfaction
- Resolved complex customer issues in a timely manner while maintaining positive relationships with clients
- Managed a portfolio of accounts by providing timely support and guidance
- Cultivated strong client relationships through proactive communication and problem-solving
- Successfully manage network business relationships with assigned leased network partners and Zelis Proprietary Networks for medical, dental, and worker's compensation products
- Proactively analyze network performance results on a monthly/quarterly basis to monitor trends and seek new growth opportunities
- Schedule monthly meetings with network partners to discuss performance and offer solutions
- Provide research, analysis, recommendations, and resolution for provider/member claims and contract disputes
- Ability to locate and interpret proprietary contracts/discount agreements to aid in both resolving issues and educating providers and internal associates
- Maintain a process of tracking/following-up to resolve issues timely and per client desired turnaround times.
- Coordinated cross-departmental efforts to execute successful marketing campaigns for key accounts.
PROVIDER RELATIONS SPECIALIST
Stratose/Zelis
03.2008 - 04.2012
- Managed and tracked the process to transmit provider disputes to Zelis leased network partners and properly documented and evaluated the returned resolution
- Maintained tracking system for scheduled follow-ups and to ensure client turnaround times were met
- Successfully managed inbound/outbound call center with calls from providers, members, clients, and network partners
- Determined the type of assistance needed by asking appropriate questions and listening attentively to identify specific issues for correct handling or escalation
- Provided first call resolution through provider education by researching and exploring answers and alternative solutions
- Created training manual for the PRS role and trained new hires
- Implemented solutions with management to better serve both internal/external needs
- Required to meet specific call center performance metrics of productivity and quality assurance
- Performed quality assurance audits on provider data to ensure accuracy of information provided
- Monitored changes in state regulations that could affect provider relations activities.
MANAGED CARE CONTRACT ANALYST
HCA
06.2005 - 03.2008
- Identified areas of risk associated with existing contracts and developed action plans to address them
- Conducted research on current trends in the healthcare industry to inform negotiation strategy
- Collaborated with internal stakeholders to ensure compliance with all applicable laws and regulations regarding managed care contracting activities
- Responsible for reviewing the contract from different insurance companies and correcting non-payment relates discrepancies
- Reviewed hospital systems to determine activity on accounts to make appropriate decisions to obtain account resolution
- Assisted in research to resolve discrepancies and was responsible for recalculation of logs after a contract or reimbursement changes/updates.
CONTRACT NEGOTIATOR
First Health
08.2000 - 08.2004
- Developed strategies to ensure successful contract negotiations that met the needs of both parties
- Identified trends in industry standards regarding contractual terms associated with specific industries
- Ensured timely delivery of goods or services by monitoring progress against contracted timelines
- Negotiated contract language and rates for the delivery services from Ancillary services and medical groups
- Prepared new Provider applications and re-credentialed applications for the Credentialing.
Education
Associate of Arts - Nursing Education
Georgia Medical Institute-Dekalb
Atlanta, GA04.1988
High School Diploma -
West Point High School
West Point, MS05.1986
Skills
- Client Relationship Management
- Team Training
- Customer Service
- Account Management
- Contract Negotiation
- Goal-Oriented
- Documentation and Reporting
- Teamwork and Collaboration
- Multitasking
- Account development
Timeline
NETWORK ACCOUNT MANAGER
Zelis
04.2012 - 11.2023
PROVIDER RELATIONS SPECIALIST
Stratose/Zelis
03.2008 - 04.2012
MANAGED CARE CONTRACT ANALYST
HCA
06.2005 - 03.2008
CONTRACT NEGOTIATOR
First Health
08.2000 - 08.2004
Associate of Arts - Nursing Education
Georgia Medical Institute-Dekalb
High School Diploma -
West Point High School
Similar Profiles
Valerie GarranderValerie Garrander
Director of Client Services at ZelisDirector of Client Services at Zelis
Jasmine ClarkeJasmine Clarke
Client Service Specialist at ZelisClient Service Specialist at Zelis
Tamekia RameyTamekia Ramey
Client Manager at Zelis HealthcareClient Manager at Zelis Healthcare
Curtis BellamyCurtis Bellamy
CKS Packaging at Machine Bagger OperatorCKS Packaging at Machine Bagger Operator
Keilah YisraelKeilah Yisrael
Rural Mail Carrier Associate at USPSRural Mail Carrier Associate at USPS