Claudia Betanco
Port Washington
Summary
Dynamic Provider Network Manager with a proven track record at Amerigroup, excelling in contract negotiation and dispute resolution. Enhanced provider satisfaction through strategic outreach initiatives and performance analysis, resulting in improved network efficiency. Skilled in fostering relationships and ensuring regulatory compliance, driving successful onboarding and education for healthcare providers.
Overview
11
11
years of professional experience
Work History
Provider Network Manager
Amerigroup
10.2007 - 05.2010
- Facilitated communication between providers and internal teams to resolve inquiries and issues.
- Coordinated training sessions for new provider onboarding, ensuring compliance with policies.
- Analyzed provider performance metrics to identify areas for improvement and support initiatives.
- Developed educational materials for providers to enhance understanding of program changes.
- Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Strengthened provider networks through regular outreach and relationship building activities.
- Researched and resolved disputes, billing discrepancies, and claims.
- Initiated physician and hospital orientations to support ongoing education of health care provider community.
- Negotiated contracts with providers, securing favorable terms while maintaining strong partnerships within the network.
Provider Relations Representative
Healthfirst
03.2005 - 09.2007
- Managed provider relationships by addressing concerns and fostering collaboration on service delivery.
- Implemented feedback processes to improve service quality and provider satisfaction rates.
- Served as a liaison between healthcare organizations and insurance companies to ensure seamless communication regarding claims processing and payment matters.
- Managed high-volume caseloads of dispute resolution cases, providing swift resolutions that maintained positive relationships with both parties involved.
- 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.
- Physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
Provider Relations Representative
WellCare of New York
01.2002 - 03.2005
- Streamlined documentation processes to enhance efficiency in managing provider records and communications.
- Supported strategic initiatives that improved overall network performance and operational outcomes.
- Researched and resolved disputes, billing discrepancies, and claims
- Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
- Identified network gaps, and recruited providers to fill deficiencies.
- Conducted regular audits of provider records, identifying discrepancies and ensuring accuracy in information.
Enrollment Specialist
WellCare of New York
01.1999 - 01.2002
- Managed high volume of applications accurately, maintaining strict adherence to deadlines and regulatory requirements.
- Ensured accuracy of client records by diligently updating information systems following changes in personal or eligibility details.
- Assisted clients in navigating complex healthcare system, clarifying policies and processes for informed decisionmaking.
- Maintained up-to-date knowledge of industry trends and changing regulations, ensuring compliance in all tasks performed.
- Coordinated outreach efforts to raise awareness of available health insurance programs within the community.
Education
High School Diploma -
Bayside High School
Bayside, NYSkills
- Provider relations
- Contract negotiation
- Dispute resolution
- Performance analysis
- Network development
- Documentation management
- Regulatory compliance
- Physician recruitment
- Network troubleshooting
- Team leadership
- Program implementation
- Outreach initiatives
Languages
Spanish
Native or Bilingual
Timeline
Provider Network Manager
Amerigroup
10.2007 - 05.2010
Provider Relations Representative
Healthfirst
03.2005 - 09.2007
Provider Relations Representative
WellCare of New York
01.2002 - 03.2005
Enrollment Specialist
WellCare of New York
01.1999 - 01.2002
High School Diploma -
Bayside High School