Ebony Maxwell
Pflugerville,TX
Summary
Healthcare Operations Specialist Experienced Healthcare Operations Specialist with 12 years of experience with reliable time management and leadership skills within the medical and dental managed care industry. Experience in resolving complex claims to ensure proper payment for rendered services totaling up to $1,000,000 for a provider group. Top performer who provides support by gaining knowledge within the managed care industry.
Overview
11
11
years of professional experience
1
1
Certificate
Work History
Payer Contracting Specialist
Sound Physicians
Tacoma, WA
09.2023 - Current
- Developed strong client relationships through consistent communication and attentive service.
- Earned recognition as a top performer consistently exceeding targets throughout my tenure as a specialist in the field.
- Reduced costs by identifying inefficiencies in operations and implementing cost-saving measures.
- Supported creation of detailed, technical financial models to value potential acquisition targets.
- Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
- Educated staff on organizational mission and goals to help employees achieve success.
- Generated reports detailing findings and recommendations.
- Developed effective improvement plans in alignment with goals and specifications.
Provider Relations Account Executive
Ascension Health
Austin, TX
01.2023 - 09.2023
- Work cooperatively with provider personnel to expedite service delivery, ensure delivery, and ensure appropriate service billing
- Educates providers and office staff on specifics of credentialed insurance plans ensuring knowledge of Dell Children’s Health Plan, Seton Employee Benefits, CHIP, and Ascension Personalized Care contractual agreements and Ascension’s provider portal system
- Assist with over 300 medical providers in the Travis and Williamson County area virtually, remotely, and on-site to assist with provider issues
- Works exclusively with the internal data team to ensure provider directory reflects the internal data team to ensure the provider directory reflects the most up-to-date information for members and providers
- Perform duties as a liaison between providers, health plans, and corporate including investigating and resolving provider claims issues
- Perform training, orientation, and coaching for performance improvement within physician practices.
- Developed detailed reports analyzing account performance data, providing valuable insights for future strategy adjustments or improvements
- Provided exceptional customer service, addressing client concerns promptly and effectively to ensure long-term loyalty
- Strengthened customer relationships with a proactive and collaborative approach to managing needs
Provider Relations Specialist
Bright Healthcare
Austin, TX
08.2021 - 12.2022
- Educated providers and office staff on specifics of credentialed insurance plans ensuring knowledge of Individual Family Plan contractual agreements and the Availity provider portal system
- Assisted with over 500 medical providers in the Travis and Williamson County area virtually, remotely, and on-site to assist with provider issues
- Co-led Joint Operation Committees (JOC) for provider groups within the market
- Coordinated (or collaborated in) prompt claims resolution through direct contact with providers, claims, pricing, and medical management departments
- Led new employees and implemented new processes for a new network in the Austin Market
- Researched issues that could impact provider negotiations and hold network retention
- Helped build out the Austin market to ensure the company met network adequacy for members to access top-quality providers
- Built and maintained the Austin provider network in the central Texas Region, onboarding more than 500 providers and expanding customer access
- Created training and protocol manuals for the Provider Relations Department
- Worked exclusively with the internal data team to ensure the provider directory reflected the most up-to-date information for members and providers
- Delivered presentations in partnership with external stakeholders and executives
- Managed and delivered provider reporting to the Vice President of Provider Relations
- Ensured continuous quality improvement related to provider integrations
- Exceeded goals landing within the top 10th percentile in performance ratings within six months of being with the company
- Received the “Golden Hat Award’ for being an exceptional team player in January 2022.
- Supported organizational growth through active participation in strategic planning discussions focused on expanding the provider network
- Coordinated training sessions for providers, ensuring proper understanding of policies and procedures
Program Specialist III
Texas Health and Human Services Commission
Austin, TX
02.2020 - 08.2021
- Completed a backlog of 170 Medicaid credentialing and re-credentialing applications within a four-month time frame
- Served as a primary source for Long Term Care Medicaid Providers creating 90% faster processing of provider applications
- Provided application information for TMHP and other Managed Care Organizations for new and existing provider applications
- Responded to all requests within an timely manner for information about the Medicare and Medicaid enrollment process.
- Achieved successful outcomes for multiple projects through effective project management and collaboration with stakeholders
- Enhanced program efficiency by streamlining processes and implementing innovative strategies
- Facilitated cross-functional team collaborations, fostering an environment of continuous improvement and innovation
- Built strong relationships with external partners to secure resources and support necessary for program success
Provider Partner Representative III
DentaQuest
Austin, TX
01.2016 - 03.2019
- Educated providers and office staff on specifics of credentialed insurance plans ensuring knowledge of Medicaid/ Medicare contractual agreements and provider portal systems
- Oversaw over 200 dental providers in the Central Texas area virtually, remotely, and on-site to assist with provider issues
- Maintained providers’ compliance with state and insurance contracts through a developed understanding of contract
- Expectations and corporate benefits, preventing allegations of improper handling
- Delivered excellent provider service by educating providers about monthly utilization, plan reimbursements, and plan limitations.
- Advised clients on regulatory compliance matters to mitigate risks associated with potential violations or penalties
- Fostered an atmosphere of continuous learning by leading seminars or workshops on relevant topics
Complaints and Grievance Specialist II
DentaQuest
Austin, TX
08.2014 - 01.2016
- Investigated complex complaints, member grievances, and appeals from Medicaid providers concerning allowed benefits, expectations, and policy procedures.
- Consistently met performance metrics such as quality scores and case closure rates, demonstrating a commitment to excellence in handling customer grievances
- Reduced case backlog by prioritizing urgent grievances and implementing efficient workflows
- Managed grievance cases for timely resolutions, enhancing company's reputation
- Maintained detailed records of all grievance cases, ensuring accurate reporting and data analysis opportunities
Provider Specialist Rep II
DentaQuest
Austin, TX
04.2013 - 12.2014
- Assisted Texas and Colorado Medicaid providers with provider support, verified insurance coverage and benefits, billing, and claims questions bettering their understanding of the outcome of their claims.
- Provided exceptional support to providers, resulting in improved retention rates and overall satisfaction
- Implemented quality improvement initiatives for better service delivery to clients
- Handled escalated or complex inquiries from providers by applying problem-solving skills leading to satisfactory resolutions
Education
BBA - Business Administration
Huston-Tillotson University
Austin, TXMay 2025
Skills
- Contract Negotiation
- Account Management
- Customer Service
- Revenue Generation
- Strong relationships
- Operations
- Excellent Communication
- Self Motivation
- Time Management
- Decision-Making
- Attention to Detail
- Adaptability and Flexibility
- Team building
- Teamwork and Collaboration
- Problem-Solving
- Interpersonal Communication
Timeline
Payer Contracting Specialist
Sound Physicians
09.2023 - Current
Provider Relations Account Executive
Ascension Health
01.2023 - 09.2023
Provider Relations Specialist
Bright Healthcare
08.2021 - 12.2022
Program Specialist III
Texas Health and Human Services Commission
02.2020 - 08.2021
Provider Partner Representative III
DentaQuest
01.2016 - 03.2019
Complaints and Grievance Specialist II
DentaQuest
08.2014 - 01.2016
Provider Specialist Rep II
DentaQuest
04.2013 - 12.2014
BBA - Business Administration
Huston-Tillotson University
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