Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
Generic

Gejuan Long

Greenbelt,Maryland

Summary

Seeking a position in a progressive organization to maximize my skill-sets within healthcare administration, leadership, communication and networking.

Seasoned in elevating healthcare outcomes, I excel in contract negotiations and provider relationship management. Demonstrated leadership in orchestrating various contract agreements, I leverage my effective communication and critical thinking skills to enhance provider networks. My adeptness in medical billing and mentoring underscores my comprehensive skill set, driving substantial growth and operational excellence.

Overview

8
8
years of professional experience

Work History

Senior Provider Contract Negotiation Professional

Humana Inc.
03.2023 - Current
  • Negotiated reimbursement rates for Medicare and Medicaid with executives, physicians, skilled nursing facilities, hospitals, ancillary providers and large medical groups in Virginia
  • Identified and analyzed provider gaps in the Virginia market to develop new business and maintain existing accounts and networks.
  • Daily communication with over 30 C-Suite level executives, hospitals and skilled nursing facilities to maintain contractual obligations and provider relationships
  • Aligned with CMS guidelines to ensure a quality healthcare experience for members and providers
  • Led project based initiatives using actuarial models to predict Provider outcomes and develop networks.

Provider Contract Installation Professional

Humana Inc.
12.2021 - 03.2023
  • Supported vale based providers in the New York Medicare market, by verifying that contractual payments were set up in Humana's payment systems
  • Lead weekly meetings to align with various departments about how to resolve contractual questions or concerns
  • Met monthly deadlines to ensure that providers were reimbursed in a timely manner
  • Provided assistance to over 60 healthcare organizations regarding contractual obligations
  • Navigated multiple data driven systems to process payments, claims, network status and contractual agreements

Health Insurance Verification Specialist

IBM
06.2021 - 12.2021
  • Supporting health insurance consumers through Cigna contracts, to help verify and process pharmacy and insurance information
  • Navigated data heavy systems to process claims, benefits, and prescriptions for members
  • Daily communication with provider offices and members to help resolve issues regarding prior authorizations, copays, and any gaps in coverage
  • Trained incoming and current employees on day-to-day processes and procedures

Provider Executive Consultant

Optum
09.2020 - 05.2021
  • Daily communication with healthcare executives to help met various needs and answer health care questions
  • Responsible for pulling data centric reports within a desired time frame to meet the needs of healthcare executives
  • Scheduled meetings between expert partners and key healthcare stakeholders
  • Navigated through data centric systems to troubleshoot and innovate quality outcomes

Sr. Special Needs Clinical Advisor

UnitedHealth Group
03.2019 - 09.2020
  • Administer benefits to members in an effective and clear manner
  • Advise and educate families on the proper way to engage in their healthcare policy through claims, benefits, financial accounts, appeals & grievances, pharmacy, and behavioral health
  • Daily communication with provider offices to properly process benefits and claims for members and providers
  • Navigated through multiple systems to provide quality healthcare experience
  • Supervised a pilot program to improve daily processes

Delivery Technician/ Receptionist

Apria Healthcare
07.2018 - 03.2019
  • Delivered home respiratory and DME equipment to patient homes and healthcare centers
  • Responsible for proper documentation coinciding with the DOT, FDA, Joint Commission, Medicare, and Medicaid
  • Directed patients over the phone to best assist their needs and concerns
  • Communicated with case managers, sales representatives, and patients daily to ensure a quality care experience

Medical Intake Coordinator

Winston-Salem Rescue Mission
01.2017 - 06.2018
  • Responsible for patient intake and discharge
  • Assisted on the creation of various policies and procedures
  • Filed and organized patient profiles
  • Demonstrated critical thinking skills when faced with ethical organizational dilemmas

Education

Master of Health Administration (MHA) -

Winston-Salem State University
Winston-Salem, NC
05.2019

Bachelor of Science - Health Care Management

Winston-Salem State University
Winston-Salem, NC
05.2017

Skills

  • Effective Communicator
  • Competent in healthcare insurance claims
  • Adaptive/Critical Thinker
  • Leadership/Mentoring qualities
  • Proficient in medical billing
  • Contract Negotiations
  • Provider Relationship Management

Affiliations

  • Health Care Professionals Club, Member, 09/01/15
  • SAAC, Representative, 2015-2016 Academic Year
  • Local Recreation Centers, Volunteer, Present
  • Kappa Alpha Psi Fraternity, Inc., Member

Timeline

Senior Provider Contract Negotiation Professional

Humana Inc.
03.2023 - Current

Provider Contract Installation Professional

Humana Inc.
12.2021 - 03.2023

Health Insurance Verification Specialist

IBM
06.2021 - 12.2021

Provider Executive Consultant

Optum
09.2020 - 05.2021

Sr. Special Needs Clinical Advisor

UnitedHealth Group
03.2019 - 09.2020

Delivery Technician/ Receptionist

Apria Healthcare
07.2018 - 03.2019

Medical Intake Coordinator

Winston-Salem Rescue Mission
01.2017 - 06.2018

Master of Health Administration (MHA) -

Winston-Salem State University

Bachelor of Science - Health Care Management

Winston-Salem State University

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