Ginger Spells
Summary
Accomplished operations leader who is service-oriented and performance-driven with excellent organizational, multitasking, and problem-solving abilities. Experienced in catapulting client engagement, performance development, and satisfactory experience in building long-term relationships. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
12
12
years of professional experience
Work History
Provider Relations Manager
Avesis LLC
11.2021 - 10.2023
- Managed day-to-day activities within the Provider Relations Department consisting of dental and vision supervisors and representatives to support government and commercial programs across multiple markets.
- Enhanced provider relations by conducting regular visits, issue resolution, and maintaining open communication channels with network providers.
- Improved provider satisfaction through the development and implementation of targeted training programs for provider education on company's policies and procedures.
- Analyzed data from various sources to identify trends, anticipate future needs, and accomplished strategic planning related to provider relations.
- Collaborated with cross-functional teams to address contractual issues, ensuring timely resolution and minimizing disruption to services.
- Identified opportunities for process improvement within the provider relations department, implementing changes that led to increased efficiency and cost savings.
- Negotiated favorable contract terms with new partners while maintaining positive relationships with existing ones, leading to sustained growth in the provider network.
- Reviewed financial performance data for contracted providers regularly, identifying areas where improvements could be made in order to optimize revenue generation potential.
- Successfully resolved complex disputes involving reimbursement rates or other contractual disagreements between providers and the organization through skilled negotiation tactics.
- Developed standard operating procedures for the provider relations department, leading to increased efficiency and consistency across all functions.
Regional Provider Relations Manager
MCNA Dental
12.2011 - 11.2021
- Managed the Provider Relations department day-to-day operations in multiple markets consisting of managers, supervisors, field agents, and internal staff to ensure compliance with company policies, government laws, regulations, and contractual standards while serving as a liaison for state agencies.
- Developed and facilitated new hire training programs and on-the-job work study tools for onboarding that resulted in high performance and proficiency
- Managed monthly/quarterly/annual department performance activities to report KPIs, improving results and SLA performances exceeding contractual measures.
- Negotiated contracts and reimbursements for non-participating providers to administer covered services to insured members.
- Developed and managed appropriate outreach parameters for field reps to meet the client's expectations.
- Established strong relationships with key stakeholders in the dental industry, positioning the company as a trusted partner in Dental Benefits Administration.
- Coordinated educational events for providers aimed at increasing awareness of regulatory changes as well as best practices in oral care delivery.
- Contributed significantly towards achieving company's growth targets by effectively managing a large portfolio of network providers across different geographical regions.
- Developed, reviewed and prepared quarterly Provider Facility Performance Scorecards for quality improvement and utilization to increase efficiencies in administrative processes/billing.
- Collaborated with Network Development conducting in-depth market research to identify potential gaps in coverage to increase network adequacy and develop targeted strategies for network expansion.
- Researched and resolved disputes, billing discrepancies and claims efficiently to maintain provider satisfaction, boosting satisfaction ratings 95% or better.
Education
Visual Communications and Multimedia -
ITT Technical Institute
Judson High School
Skills
- Healthcare industry knowledge/Managed Care
- Customer Service, Quality and Training Development
- CDT Coding
- ADA Claims and Billing Processing
- Credentialing and Provider Enrollment
- Team Development Strategies
- Contract Management
- Negotiation and Conflict Resolution
- Process Improvement and Workflow Management
- Educational Presentations/Provider Orientations
- Provider Relationship Management
- Cross-functional collaboration
- Regulatory compliance
- Administration and Reporting
Timeline
Provider Relations Manager
Avesis LLC
11.2021 - 10.2023
Regional Provider Relations Manager
MCNA Dental
12.2011 - 11.2021
Visual Communications and Multimedia -
ITT Technical Institute
Judson High School
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