Cora Ross McBride
Las Vegas,NV
Overview
39
39
years of professional experience
Work History
Provider Network Manager, Sr. Provider Solutions
Elevance Health / Blue Cross of California
01.2006 - 01.2023
- Negotiate physician and facility contracts, develop new networks and act as liaison between Contracting and Provider Relations
- Promote, market and negotiate payment innovation and cost of care initiatives
- Analyze network, identify network gaps and conduct provider recruitment
- Facilitate physician credentialing and physician system upload
- Serve as lead over a contracting team engaged in various network management related activities
- Take leadership role in mentoring and training other network managers
Senior Network Education Representative
State Sponsored Business
01.1999 - 01.2006
- Analyze network, identify network gaps and conduct provider recruitment
- Facilitate contract completion, credentialing and facility review
- Develop, facilitate and evaluate provider education and training
- Promote member enrollment and retention of existing members
- Facilitate resolution to claims issues through training and advocacy
- Support and complete other special projects as assigned
Provider Network Analyst
State Sponsored Programs
01.1996 - 01.1999
- Monitor and analyze network of providers
- Interface with Database Management System to insure loading of network providers
- Create and maintain reports to demonstrate compliance and adequacy of the network
- Create, maintain and publish provider directories
- Maintain good rapport with providers and provide correction and appropriate follow-up when deficiency is discovered
Unit Lead, Customer Service Representative/Claims Examiner, Operations
State Sponsored Programs
Camarillo
01.1994 - 01.1996
- Processing of all types of claims including high dollar hospital and professional claims
- Perform adjustment of overpayment and underpayment of claims
- Respond to customer service issues in all areas particularly provider claim issues
- Provide training to new employees
- Handle supervisory calls
- Assist in the supervision of employees
Security Supervisor; Administrative Mgr
Burns Security; American Protective
Universal City, CA
03.1984 - 09.1993
- Conducted regular patrols of facility to detect and deter security threats.
- Recorded incident reports with detailed accounts of occurrences.
- Monitored alarm systems and CCTV footage to enable prompt attention and response.
- Closely monitored alarm systems, responding promptly to alerts and coordinating appropriate action when necessary.
Education
Bachelor of Science - Marketing
University of Nueva Caceres
Associates Degree -
Ateneo de Naga University
Karrass training -
Karrass Effective Negotiations
Skills
- Effective leadership and negotiating skills
- Network analysis and data reporting
- Excellent people and relationship building skills
- Excellent written skills
- Access
- PowerPoint
- Excel
- MS Office
- MS Project Management
- Working knowledge of WGS - claims and reimbursement, reporting and provider upload systems
Major Accomplishments
- Healthy Families-AIM EPO Re-contracting Project in California, 01/01/09 - 12/31/10
- CAP Conversion Project in California, 01/01/07 - Present
- Network Development projects in Nevada, Kansas, Texas, Virginia, Oklahoma and California, 01/01/98 - 12/31/06
- Recipient, WellPoint Honor Awards, 01/01/03
Timeline
Provider Network Manager, Sr. Provider Solutions
Elevance Health / Blue Cross of California
01.2006 - 01.2023
Senior Network Education Representative
State Sponsored Business
01.1999 - 01.2006
Provider Network Analyst
State Sponsored Programs
01.1996 - 01.1999
Unit Lead, Customer Service Representative/Claims Examiner, Operations
State Sponsored Programs
01.1994 - 01.1996
Security Supervisor; Administrative Mgr
Burns Security; American Protective
03.1984 - 09.1993
Bachelor of Science - Marketing
University of Nueva Caceres
Associates Degree -
Ateneo de Naga University
Karrass training -
Karrass Effective Negotiations