Diana Espinoza
Orange Park,FL
Summary
Provider Relations Coordinator with extensive experience at Modivcare Solutions, specializing in contract negotiation and network development. Expertise in claims processing and communication management, fostering strong provider relationships to ensure compliance and operational efficiency. Achievements include enhancing collaboration and increasing provider satisfaction through targeted outreach initiatives.
Overview
19
19
years of professional experience
Work History
Provider Relations Coordinator
Celebration Church Orange Park
Orange Park, FL
08.2024 - 08.2025
- Coordinated communication between providers and church staff to enhance collaboration.
- Conducted regular meetings with providers to discuss updates and feedback.
- Developed training materials for providers on church policies and procedures.
- Coordinated provider network meetings, events and trainings.
- Facilitated outreach initiatives to strengthen community ties with local providers.
- Performed administrative tasks such as filing, scanning, photocopying.
- Resolved provider inquiries and issues related to reimbursement, claims processing and other operational matters.
- Maintained records of all correspondence between the organization and its providers.
Medical Transportation Coordinator/Manager - Temporary
Key Medical Transport
Orange Park, Florida
11.2023 - 06.2024
- Coordinated daily non-emergency Patient Transportation services with effective monitoring.
- Managed and monitored transportation routes for optimal efficiency.
- Executed timely dispatch of patient transportation requests, ensuring accuracy.
- Handled Human Resources responsibilities, including employee relations and benefits management.
- Maintained employee records with precision and confidentiality.
- Reviewed and updated policies to comply with company regulations and laws.
- Ensured drivers maintained active credentials by verifying required documentation.
- Updated vehicle records and conducted monthly inspections for compliance.
Provider Relations Coordinator/Manager
Modivcare Solutions
01.2022 - 06.2023
- Develop relationship with the transportation provider and establish expectations.
- Assist the PRM in different areas such as network development in region 3 and region 4.
- Contract providers in network and out of network providers, rate amendments review and approval for providers.
- Assist the providers in getting access to complicore auto insurance, drivers update, vehicle updates.
- Follow up with on-time performance and digitization, sent email with the scorecards on a weekly basis to the providers, upload complaints, TPNS in Tables Report.
- Assign standing orders to our providers (dialysis, med management and on demand trips).
- Maintain open communication with our Liaison, Routers and Credential Department.
- Guide and direct the transportation providers to achieve the Modivcare goals.
- Manage, provide resolution to our providers, and prevent deficiencies.
- Provide weekly report to the provider relations manager and region manager.
- Assist with negotiating rates with providers.
- Assist the TP on-boarding, emphasized the policy for credential department (vehicles & drivers).
- Finalizing contract rates.
- Approve cost override.
- Assist in training for new transportation providers and existing providers.
Consumer Access Specialist
Advent Health Hospital
Celebration, Florida
07.2021 - 01.2022
- Accountable for maintaining a working relationship with clinical partners to ensure open communication between clinical, ancillary, and patient access departments, which enhances patient experience.
- Ensure patient account are assigned the appropriate payor plans.
- Ensures all financial assessments, eligibility and benefits are updated.
- Creates accurate estimate based on the patient insurance for surgery center, cash collection, co pays, deductibles and co-insurance.
- Knowledge of CPT-4 codes and ICD-9.
- Provide personified estimate of patient financial responsibility based on their insurance coverage.
- Minimizes duplication of medical records.
- Collect adheres to HIPPA regulations and Advent Health Corporate Policies.
- Registration patients for all services, emergency room, admission, same day surgery, In-patient and Out-patient procedures, X-rays, CT scans, Cardiology, lab, pain management, Cardiology Rehab.
- Responsible for register patients by obtaining critical demographic elements from patients.
- Performs Medicare review on all applicable Medicare accounts to determine coverage.
- Identifies patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABN’s).
- Complete Medicare Secondary Payer Questionnaire or Medicare beneficiaries.
- Order Transportation for patients.
- Obtain pre-authorizations from third party payers in accordance with payer requirements and within established timeframe before scheduled appointments.
Customer Service Representative
LogistiCare/Conduit Global/Modivcare
01.2020 - 01.2021
- Making new reservation, updating existing reservation for Non-Medical Emergency Transportation.
- Setting up a discharged from hospital for members in wheelchair, stretcher, or ambulatory.
- Activate Lyft rides and will calls for members to get picked up at the facilities.
- Submit documents for Gas Reimbursement.
- Verify a member eligibility with many insurances such as (Medicare, Medicaid, Aetna, NYC MLTC and other insurances.
- Knowledge using the LCAD program.
- Intake/Outbound calls.
- Activate will call.
- Submitting complaints on behalf of the member.
- Transferring calls to different departments such as: Member services, Eligibility, help line, or Escalation.
Bookkeeper/Secretary/Manager
Duval County Public Schools
Jacksonville, Florida
01.2017 - 01.2018
- Internal Accounts, SAP (PCF, budget transfers) Purchase requisition order and approved vendors.
- Payroll, leave forms, printing timesheets and timekeeping.
- Overall human resources duties.
- Reconcile monthly bank statements, make payments to other vendors, deposit money, dropped money (utilize the Vault log), KEV, Returned of District Trust Money, NSF, good receipt, and invoice.
- Entering deposits, itemizing checks, issuing receipts.
- Print statements, printing deposit slips, adding deposits to ledger.
- Supervise employee attendance, coordinate with Kelly Services substitutes teachers and paraprofessionals.
- Maintain records for teacher’s certifications and emergency contact information.
- Inventory supply control, ordering supplies for the school, Keys, distribute school mail, update School Directory and employees Birthdates, Spring /Fall Pictures and set up/break down special events.
- Maintain Fire/Emergency drill documents and maintain incident reports, Equipment/ Furniture Transfer.
- Coordinate for special events, fundraising and field trips, buses, and vouchers (STEAM).
- Utilize a multiline/ transfer phone calls to correct department.
Customer Service Associate
Bed Bath and Beyond
Jacksonville, Florida
01.2015 - 2017
- Assist customers with the widest range of quality merchandise in the sales department.
- Accept and process special online orders and new beyond orders.
- Cashier front line when needed, monitor alarm, and log it appropriately.
- Answering high volume of phone calls, establish reason for calling, redirect calls.
- Operate intercom and two-way radio.
- Entry all damage, broken used merchandise into the computer system.
- Ensure the inventory levels for merchandise are maintain, restock, and replenish.
Special Education Student Focused Paraprofessional
Duval County Public Schools
Jacksonville, Florida
01.2016 - 01.2017
- Assist teacher in the classroom with special needs students.
- Supervise student in the classroom and outside the classroom.
- Provide administrative support for teaching and additional enrichment activities for the students and One-One (1:1) focus Paraprofessional.
- Contribute with the student developmental skills and testing.
- Facilitate appropriate social interaction amongst the students by reinforcing positive behavior and group activities, Promote independency, good behavior, and self-confidence.
- Assist students in various settings, such as arrival and dismissal time.
- Escort and assist students to the restroom, washing hands, changing diapers or clothing as needed.
- Help the students more hands-on learning activities that help to drive concepts home.
IRS Contact Service Representative
Internal Revenue Service
Jacksonville, Florida
01.2014 - 07.2014
- Utilized computer systems to locate taxpayer accounts for administrative and technical tasks.
- Transferred inbound calls to appropriate departments for efficient resolution.
- Assisted customers with inquiries on notices and assignments.
- Advised taxpayers on potential enforcement actions, promoting voluntary tax law compliance.
- Verified posting transactions to maintain single and multiple accounts.
- Estimated payment arrangements for the current year based on financial assessments.
- Mailed letters regarding non-payment, late payments, or overpayments.
- Provided guidance on IRS website navigation for customer assistance.
Customer Service Representative- Tier 1 Full-Time
Wide Open West
Colorado Springs, Colorado
01.2007 - 01.2009
- New sales, installation, process payments, disconnect cable services.
- Order new equipment for customers.
- Reboot operating System/Troubleshooting cable boxes.
- Apply discount to the customer’s account, collect payments, and set up payment arrangements when needed.
- Assist the clients with technical support.
- Meet daily goals set by the department.
- Follow 20 + approved scripts, ensure members understand and were comfortable with the terms.
- Make an average of 50 outbound calls.
Education
Associate - General Studies - Psychology
Pikes Peak Community College
Colorado Springs, Colorado01.2013
Medical Assistant - Front Desk, Medical Billing and CPT Coding, Anatomy I & II, Computer Literacy
Sandford College
Tampa, Florida01.2005
H & S Associates - San Antonio, Texas
Educators and Consultants in Long Term Care
San Antonio, Texas01.1995
EMT-Paramedic - Rio Piedras, PuertoRico
University of Puerto Rico, Medical Sciences Campus
Rio Piedras, PuertoRico01.1990
Skills
- Provider relations
- Claims processing
- Contract negotiation
- Network development
- Regulatory compliance
- Communication management
References
- Carmelo Quinones, EMT Supervisor, 787-243-3914
- Linda Pratt, Principal Mt Herman Exceptional Student Center, (904) 630-6740
- J. Ortiz, Teacher at Mt. Herman, (904) 365-9340
- Mike Owellette, Supervisor, (719) 330-5658, mikeyoboss@hotmail.com
- Paula, Paraprofessional at Mt Herman, (904) 226-2248
- Stacy Hannah, (909) 629-0674
References
References available upon request.
Timeline
Provider Relations Coordinator
Celebration Church Orange Park
08.2024 - 08.2025
Medical Transportation Coordinator/Manager - Temporary
Key Medical Transport
11.2023 - 06.2024
Provider Relations Coordinator/Manager
Modivcare Solutions
01.2022 - 06.2023
Consumer Access Specialist
Advent Health Hospital
07.2021 - 01.2022
Customer Service Representative
LogistiCare/Conduit Global/Modivcare
01.2020 - 01.2021
Bookkeeper/Secretary/Manager
Duval County Public Schools
01.2017 - 01.2018
Special Education Student Focused Paraprofessional
Duval County Public Schools
01.2016 - 01.2017
Customer Service Associate
Bed Bath and Beyond
01.2015 - 2017
IRS Contact Service Representative
Internal Revenue Service
01.2014 - 07.2014
Customer Service Representative- Tier 1 Full-Time
Wide Open West
01.2007 - 01.2009
Associate - General Studies - Psychology
Pikes Peak Community College
Medical Assistant - Front Desk, Medical Billing and CPT Coding, Anatomy I & II, Computer Literacy
Sandford College
H & S Associates - San Antonio, Texas
Educators and Consultants in Long Term Care
EMT-Paramedic - Rio Piedras, PuertoRico
University of Puerto Rico, Medical Sciences Campus