Juliana Mata
Dallas,TX
Summary
Client-focused professional with expertise in healthcare management and provider networking. Demonstrated success in aligning technology solutions with business objectives and collaborating with stakeholders to deliver effective provider solutions. Experienced management consultant with a strong background in business operations, compliance, and standard procedures. Strategic leader with a results-driven approach across diverse industries.
Overview
14
14
years of professional experience
Work History
Network Management Consultant
Blue Cross Blue Shield Of TX
Richardson, TX
02.2025 - Current
- Drafted and sent agreements to providers for adding products to existing contracts.
- Assisted providers with contracting inquiries to ensure clarity and compliance
Molina Healthcare TX
01.2012 - 10.2024
- Provider contracts 11/2018 – 10/2024
- Team Lead 8/2016-11/20 – 11/2018
- Senior Member Service representative 6/2015 – 8/2016
- Member service representative 1/2012 – 6/2015
- Assisted providers with their request to join Molina network
- Negotiated contract rates
- Reached out directly to providers should any necessary forms be required to complete and/or continue contracting process
- Handled priority accounts for multiple groups
- Audit accounts to ensure contracts were accurately loaded into billing system
- Collaborate with collages should any questions arise during contracting process
- Acted as a subject matter resource expert across multiple lines of business
- Contracted Behavioral health providers as well as hospitals, specialists, home health and ancillary providers
Education
High School Diploma -
Garfield High School
Los Angeles, CA06-1992
Some College (No Degree) - Pharmacy Tech
American Career College
CASkills
- Provider network management
- Claims processing expertise
- Microsoft Office proficiency
- Adobe software skills
- Data analysis and insights
- Client-focused solutions
- Healthcare management strategies
- Technology-driven solutions
- Business needs assessment
- Collaborative teamwork
- Medical claims data handling
- Customer service excellence
- Contract negotiation skills
Languages
Spanish
Professional
Timeline
Network Management Consultant
Blue Cross Blue Shield Of TX
02.2025 - Current
Molina Healthcare TX
01.2012 - 10.2024
High School Diploma -
Garfield High School
Some College (No Degree) - Pharmacy Tech
American Career College
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