Cynthia E. Garza
Summary
Accomplished Regional Manager skilled in fostering provider relations and managing high-performing teams. Dedicated to developing and implementing policies that streamline operations and enhance provider engagement. Expertise in budget management and compliance monitoring, contributing to the overall success of the organization.
Overview
413
413
years of professional experience
Work History
Regional Manager, Provider Relations
Centene Corporation
08.2020 - 11.2424
- Led Provider Relations department, negotiating contracts and ensuring compliance with organizational policies.
- Oversee the Provider Relations department to ensure compliance with company policies and standards, government laws, regulations and contracting standards.
- Maintain existing and developed new provider relations while assisting with contracting activities.
- Initiate and execute standard physician and ancillary provider contracts.
- Coordinate all pre-contract activities with providers such as site visits, credentialing, orientation to contractual requirements, etc.
- Manage and coordinate customized provider contracts and hospital contracts.
- Participate in physician and ancillary provider contracting and provider relations in foreign state markets through implementation and startup phases.
- Develop, implement and maintain production and quality standards for the contracting staff.
- Manage the staff in contracting areas including workflow, training and communication standards.
- Develop and oversee the training program for the Provider Relations Department.
- Create effective organizational structure and develop staff skills and competencies.
- Prepared and analyzed reports on departmental activities, recommending improvements to optimize provider relations.
- Ensure timely Provider set up processing, auditing and distribution of Provider Relations data management.
- Monitor and analyze costs and prepare departmental budget.
- Developed, implemented, and monitored policies and procedures to enhance operational efficiency.
- Develop tactical plans to align strategies and technologies with future needs.
- Prepare and analyze information to evaluate the need for additional health plan providers.
- Superior HealthPlan
Provider Account Manager II
Centene Corporation
03.2019 - 08.2020
- Acted as the primary contact for Providers, connecting them with the Health Plan and Corporate Office to provide outreach and support.
- Monitored and reported on regional outreach activities for management review, ensuring compliance with Health Plan, Corporate, and State policies while managing day-to-day workflow of network accounts.
- Performed the development, implementation and monitoring of quality initiatives to achieve plan desired outcomes for assigned regional projects as Lead.
- Reviewed and audited network accounts documentation to ensure adherence to health plan and State standards, facilitating compliance and quality assurance.
- Tasked to oversee the planning of Health Plan sponsored events and acted as host for Network accounts.
- Developed and recommended updates to policies and procedures to ensure Provider information and resources are accurate and up to date.
- Supervised the day-to-day workflow of the Account Managers and Network accounts to ensure compliance with Health Plan, Corporate, and State policies, procedures, and guidelines.
- Review and assist Providers in contracting activities to minimize contract implementation issues/errors.
- Participate in responding to urgent and emergent Provider issues.
- Currently, I participate in ensuring goals and objectives are met through coaching, training, and development.
- Maintain weekly, monthly, and quarterly reporting timelines including workload weight review posting.
- Serve as Lead for weekly Team Chat reviews, trend tracking and reporting via the Business Review Report.
- Update cross functional participation and initiative regional dashboard reporting.
- Actively participate in SWO initiatives and outreach projects.
- Complete any additional leadership assignment or reporting to the Statewide Operations.
- Analyze, develop, and implement quality initiative to achieve positive outcomes for assigned projects and outreaches.
- Receive, document, and respond to all escalated provider issues and ensure standards are established, met and maintained for issues or concerns received.
- Have participated and completed planning, coordination and participated in scheduled and unscheduled meetings with Network Account Managers to conduct orientations, train on health plan policies and procedures, deliver materials or inquire about contracting with our Health Plan.
- Analyze and assisted in development and implementation and monitoring of quality initiatives to achieve successful outcomes for assigned projects.
- Assist in the resolution of claims payment and provider systems set-up issues.
- Review and assign Regional Provider Orientation and Webinars for the year including Account Manager assignment and guided preparation.
- Develop work processes and detailed project planning for Account Managers.
- Conducted monthly face-to-face meetings with top Tier 0 and Tier 1 Network Providers to educate them on policies and procedures for performance improvement.
- Responsibilities also include training, orientation, coaching, investigation, response, and resolving provider claims issues, educating on referrals and authorizations, claims submissions, and web site education.
- Contributed as a member of Superior Health Plan's Cross Functional Support Team and served as the area AM II across multiple counties, including Willacy, Cameron, Hidalgo, and Starr.
- Participated in outreach projects, including P.R.O.M.T., HHSC Town Hall Meetings, JOM's, Conventions/Conferences, After Hours/Linguistic Outreach, ECI Meetings, HHSC Meetings, and various in-house projects.
- Knowledge of multiple work systems including Amisys, Macess, Provider DataBase, PDU, Portico, Firefly, SharePoint, Provider Visit Database, Treo, Outlook, Citrix, CRM/OMNI conversion, Compliance 360, Web Portal, and CNET.
- Organized and Completed Provider Advisory Group Meeting Lead, Team Education Cross training, Statewide Webinars including presentation, development and execution.
- Contributed to changes for presentations and upcoming events by scheduling, conducting, and assisting at orientations or training sessions for Providers.
- Organized Quarterly Clinical Meetings, Facilitated Statewide Provider Relations Monthly Meeting, and conduct various monthly outreaches including HEDIS, New Provider Orientations, New Product Orientations and special outreach initiatives.
- Completed various additional assignments to support team objectives.
- Superior HealthPlan
Provider Relations Specialist II/Account Manager
Centene Corporation
04.2015 - 03.2019
- Provided outreach and support as the primary contact for providers, facilitating communication between the providers, the health plan, and corporate office.
- Monitored and reported WIGs and Regional Outreaches for management review, ensuring compliance with Health Plan, Corporate, and State policies while maintaining day-to-day workflow of network accounts.
- Tasked to oversee the planning of Health Plan sponsored events and acted as host for Network accounts.
- Developed and recommended updates to policies and procedures to ensure Provider information and resources are accurate and up to date.
- Supervised the day-to-day workflow of Account Managers and Network accounts in compliance with Health Plan, Corporate, and State policies, procedures, and guidelines.
- Review and assist Providers in contracting activities to minimize contract implementation issues/errors.
- Participate in responding to urgent and emergent Provider issues.
- Currently, as interim floor Supervisor oversee that Account Management Team I participate in ensuring goals and objectives are met through coaching, training, and development.
- Maintain weekly, monthly, and quarterly reporting for Regional and Corporate reporting including Region 4 WIG's.
- Analyze, develop, and implement quality initiatives to achieve positive outcomes for assigned projects and outreaches.
- Receive, document, and respond to all escalated provider issues and ensure standards are established, met and maintained for issues or concerns received.
- Coordinated scheduled and unscheduled meetings with Network Account Representatives to conduct orientations, train on health plan policies and procedures, and deliver materials related to contracting.
- Analyze and assist in development and implementation and monitoring of quality initiatives to achieve successful outcomes for assigned projects.
- Assist in the resolution of claims payment and provider systems set-up issues.
- Complete and assist in the development of processes and procedures and updating PR Team processes, agendas, and work processes.
- Develop work processes and detailed project planning for Account Managers.
- Conduct monthly face to face meetings with Network Providers, VIP's and Hospitals, providing education regarding policies and procedures related to performance improvement.
- Responsibilities also include training, orientation, coaching, investigation, response, and resolving provider claims issues, educating on referrals and authorizations, claims submissions, and website education.
- Served as a member of Superior Health Plan's Cross Functional Support Team and as the area Specialist for western Hidalgo County and Starr County.
- Currently serve as the, STAR+PLUS Subject Matter Expert, and Community First Choice Subject Matter Expert.
- Represented Region 4 in the HHSC Readiness Review for Community First Choice, Skilled Nursing Facilities, and Medicare/Medicaid Plan.
- Have participated in outreach projects including Appointment Availability, Model of Care, ICD-10, Community First Choice, Skilled Nursing Facilities, Medicaid/Medicare Plan, DME Outreach, DAHS Service Requests update, P.R.O.M.T., HHSC Town Hall Meetings, JOM's, Conventions/Conferences, After Hours/Linguistic Outreach, ECI Meetings, HHSC Meetings, and multiple in house projects including Directory, Medicaid Reenrollment, Survey Challenge, STAR Kids, Combo 4 Outreach, and Non-Compliant Member Projects.
- Knowledge of multiple work systems including Amisys, Macess, Provider DataBase, PDU, Portico, Firefly, SharePoint, Provider Visit Database, Treo, Outlook, Citrix, CRM, Compliance 360, Web Portal, and CNET.
- Organized and Completed Super Saturday Event, Provider Advisory Group Meeting Lead, Team Education Cross training, Statewide Webinars including presentation, development and execution.
- Contributed to changes for presentations and upcoming events by scheduling, conducting, and assisting at orientations and trainings for Providers.
- Organized Quarterly Clinical Meetings and facilitated Statewide Provider Relations Monthly Meetings, conducting various outreach initiatives including HEDIS, New Provider Orientations, and New Product Orientations.
- Superior HealthPlan
Provider Relations Specialist I
Centene Corporation
02.2012 - 04.2015
- Provided outreach and support as the primary contact for providers, facilitating communication between the provider, the health plan, and corporate office.
- Conducted monthly face-to-face meetings with network providers, VIPs, and hospitals to educate on policies and procedures for performance improvement.
- Responsibilities also include training, orientation, coaching, investigation, response, and resolving provider claims issues, educating on referrals and authorizations, claims submissions, and web site education.
- Served as a member of Superior Health Plan's Cross Functional Support Team and as the area Specialist for western Hidalgo County and Starr County, providing expertise as the Skilled Nursing Facility Subject Matter Expert, STAR+PLUS Subject Matter Expert, and Community First Choice Subject Matter Expert.
- Participated in outreach projects including therapy utilization review, nurse liaison, P.R.O.M.T., town hall meetings, conventions/conferences, after-hours/linguistic outreach, ECI meetings, HHSC meetings, and in-house projects such as directory, Combo 4 outreach, and non-compliant member projects.
- Organized and Completed Super Saturday Event and Statewide Webinars including presentation development and execution.
- Organized quarterly clinical meetings, facilitated statewide provider relations monthly meetings, and represented Region 4 in HHSC readiness review for nursing facilities and Community First Choice.
- Conduct various monthly outreaches including HEDIS, New Provider Orientations, New Product Orientations and special outreach initiatives.
- Superior HealthPlan
Education
Bachelor of Arts - Major: Sociology, Minor: Interdisciplinary Studies
The University of North Texas
Denton, TexasAssociates Degree - Arts - Interdisciplinary Studies
South Texas College
McAllen, TexasRegistered Medical Assistant -
Bryan Institute
Arlington, TexasGraduated -
Sharyland High School
Mission, TexasSkills
- Provider Engagement
- Provider relations
- Stakeholder Engagement
- Contract Development
- Contract negotiation
- Contract management
- Network development
- Compliance
- Customer Relationship Management (CRM)
- Client relationship building
- Negotiation
- Operations management
- Analytics Reporting
- Time management
- Critical thinking
- Problem-solving
- Adaptability
- Team collaboration
- Collaboration skills
- Microsoft Office Suite
- Contract administration
- Client relationship building
Affiliations
- Manchester's Who's Who of Business Inductee
- National's Dean's List
- University of North Texas President's List - Honors
- Alpha Kappa Delta- International Sociology Honor Society
- University of North Texas Ambassadors Program
- National Association for Multicultural Education
- Bilingual Education Student Organization
References
Available Upon Request
Languages
- Spanish
- English, Write, Read, and Speak fluently
- Spanish, Write, Read, and Speak fluently
Transcripts
Also Available Upon Request
Timeline
Regional Manager, Provider Relations
Centene Corporation
08.2020 - 11.2424
Provider Account Manager II
Centene Corporation
03.2019 - 08.2020
Provider Relations Specialist II/Account Manager
Centene Corporation
04.2015 - 03.2019
Provider Relations Specialist I
Centene Corporation
02.2012 - 04.2015
Bachelor of Arts - Major: Sociology, Minor: Interdisciplinary Studies
The University of North Texas
Associates Degree - Arts - Interdisciplinary Studies
South Texas College
Registered Medical Assistant -
Bryan Institute
Graduated -
Sharyland High School