Clara Wise
Clerical, Retail, Hospitals customer service
Arlington,Texas
Summary
Provider Relations leader committed to maintaining high customer satisfaction by providing friendly, fast service for all needs. Skillful in researching and resolving billing discrepancies and claims. Disciplined and energetic professional well-versed in medical claim appeal processing, clinical relations and medical billing. Seasoned Provider Relations Representative possessing in-depth knowledge of various insurance plans and policies. Expertise in handling high volume of calls, efficiently resolving disputes and identifying ways to improve processes. Proficient in hospital and medical offices. Communicative and detail-oriented individual with excellent interpersonal abilities.
Overview
33
33
years of professional experience
Work History
Provider Relations Coordinator
St. John's Mercy Medical Center
01.2003 - 01.2006
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings 98%.
- Increased provider satisfaction scores 98% by collecting and credentialing demographic updates, investigating claims and inquiries and overseeing network integrity.
- Developed, reviewed and prepared 15 and 20 provider education material, increasing efficiencies in processes 95%.
- Brought in 98% new providers to enhance coverage and meet program goals.
- Initiated physician and hospital orientations to support ongoing education of health care provider community.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Answered provider inquiries via email, telephone and written correspondence.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.98
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.98
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.989
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.98
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.98
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings [Number]%.
Team Leader/Union Representative
General Motors Co
01.1973 - 01.2006
- Mediated discussions between employer and employee representatives in attempt to reconcile differences.
- Participated in labor-management meetings to discuss labor issues.
- Negotiated collective bargaining agreements.
- Reduced grievances and arbitration needs by educating frontline managers on techniques for enhancing interactions between labor and leadership.
- Interpreted and advised on labor relations policies and previously negotiated agreements.
- Provided expertise on labor and employment laws to help employers make more effective decisions.
- Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
- Oversaw investigations into discrimination, sexual harassment or other workplace claims.
Sprint PCS Wireless Supervisor
Sprint Wireless Cell Phones
01.1997 - 08.2003
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Established team priorities, maintained schedules and monitored performance.
- Worked cross-functionally with various departments on projects.
- Analyzed and reported digital campaign performance with focus on program optimization.
Education
Associate of Science - Medical Insurance Coding
Hayward Adult School
Hayward, CAAssociate of Science - Business Economics
Merritt College
Oakland, CA01.1974
High School Diploma -
Hayward High School
Hayward, CA06.1972
Skills
- Customer Satisfaction
- Provider Relations
- Spanish Fluency
- Word Processing
- Marketing Analytics
- Improve Patient Care
- Information Services
- Dispute Resolution
- Outbound Surveys
- Conflict Management
- Channel Marketing
- Adaptable and Flexible
- Cash Handling
- Strong Communication and Interpersonal Skills
- Customer Assistance
- Provider Enrollment
- Customer Support
- Communications Strategies
- Cost Control
- Project Management
- Contract Amendments
- Public Relations Strategy
- Quality Assurance
Timeline
Provider Relations Coordinator
St. John's Mercy Medical Center
01.2003 - 01.2006
Sprint PCS Wireless Supervisor
Sprint Wireless Cell Phones
01.1997 - 08.2003
Team Leader/Union Representative
General Motors Co
01.1973 - 01.2006
Associate of Science - Medical Insurance Coding
Hayward Adult School
Associate of Science - Business Economics
Merritt College
High School Diploma -
Hayward High School
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