Cristiana Bernal
Las Cruces,NM
Summary
Experienced Provider Relations Representative II seeking to obtain a position as a Senior Provider Relations Representative.
Overview
31
31
years of professional experience
Work History
Provider Relations Representative II
Western Sky Community Care
Las Cruces, NM
10.2018 - Current
- Develop and maintain strong relationships with providers by responding promptly to inquiries, resolving issues and providing ongoing support.
- Research provider network strategies to ensure compliance with contractual obligations.
- Provide guidance on contract language, policy interpretation and reimbursement procedures for providers.
- Conduct site visits to evaluate current processes used by contracted providers
- Maintain accurate records of all communication with providers including emails, letters, phone calls or fax.
- Collaborate with other departments to resolve complex issues related to provider relations activities.
- Investigate concerns such as billing and claims questions on behalf of providers.
Provider Service Representative II
Molina Healthcare of New Mexico Regional Office
Las Cruces, NM
04.2012 - 10.2018
- Assisted in maintaining Provider relations with a primary focus of providing ongoing education in regard to policies and procedures.
- Aided in network development, network adequacy and provider training in alignment with core values in compliance with all federal, state and local regulations.
- Investigated concerns on billing and claims questions on behalf of Providers.
- Conducted Site visits
- Tracked all communication with Providers in accordance with policy.
Billing Collections Supervisor
Roswell Regional Hospital
Roswell, NM
09.2007 - 04.2012
- Supervised and educated staff on guidelines for correct billing and collections procedures
- Followed a set process for maintenance of billing standards
- Account management queue
- Performed billing system installation updates.
Biller/ Collections
Eastern New Mexico Medical Center
Roswell, N.M.
03.1993 - 09.2007
- Followed the set process for claims and the maintenance of billing standards
- Exceeded production standards as demonstrated through account management work queue
- Performed billing system installation updates
- Worked collections queue
- Submitted appeals
Education
Medical Terminology, Basic Computer Basic Medical Coding, HCFA 1500 Course, New Mexico Medicaid, Medicare Secondary Payor Course, Compliance Training, APC Training and HIPPA Compliance -
Training Courses
ENMU, ENMMCSkills
- Provider relationship management
- Excel and Word proficient
- Medical Terminology
- Claims review
- Excellent communication skills
- Time management
- Self-directed
- Attention to detail
- Quick learner
- Strong work ethic
References
References available upon request.
Timeline
Provider Relations Representative II
Western Sky Community Care
10.2018 - Current
Provider Service Representative II
Molina Healthcare of New Mexico Regional Office
04.2012 - 10.2018
Billing Collections Supervisor
Roswell Regional Hospital
09.2007 - 04.2012
Biller/ Collections
Eastern New Mexico Medical Center
03.1993 - 09.2007
Medical Terminology, Basic Computer Basic Medical Coding, HCFA 1500 Course, New Mexico Medicaid, Medicare Secondary Payor Course, Compliance Training, APC Training and HIPPA Compliance -
Training Courses
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