Kanya Marshall
Little Elm
Summary
Dynamic Provider Relations Advocate with extensive experience at UnitedHealth Group, excelling in complex claims resolution and process improvement. Proven track record in mentoring teams and enhancing service delivery. Skilled in UNET and effective communication, driving compliance and optimizing reimbursement strategies to elevate provider satisfaction.
Overview
18
18
years of professional experience
Work History
Provider Relations Advocate - Account Manager
UnitedHealth Group
Richardson
04.2019 - Current
- Review and research provider claim issues, identifying root causes related to contracts or processing.
- Support Advocate initiatives to improve provider service experience and resolve provider issues with internal teams.
- Present regional and market-level performance reports to management with project updates.
- Assess and interpret customer needs and requirements while identifying process improvement opportunities.
- Educate and support providers across all lines of business and monitor industry trends.
- Coordinate extensively with internal leads to understand core account portfolios and challenges.
Sr. Claims Business Process Analyst
UnitedHealth Group
04.2017 - 04.2019
- Responsible for leading and supervising Shared Savings balance billing inquiries, repricing disputes and cash up front inquiries
- Extremely successful establishing an ongoing dialogue between UHC Internal Business Partners and Shared Savings Vendors
- Educate all providers on benefits and out of network programs on how claims are processed
- Constantly use advanced analytical skills to investigate shared savings claims disputes from providers or vendors
- Regularly partner with upper management to create job aids and SOPs for all analysts.
- Responsible for generating snapshot reports designed to bring a line of sight to high-risk areas or trends
SME Provider Reimbursement Representative
UnitedHealth Group
01.2015 - 04.2017
- Ensured that all contracted rates and reimbursement policies were applied accurately.
- Proactively supported, mentored and coached all adjusters on best practices
- Reviewed complex claims and their history to determine closed/denied, paid and adjusted amounts were accurately processed for out of network providers
- Advanced user of UNET and EDSS
- Extended knowledge of manual repricing claims.
SME-OJT Provider Claim Resolution Specialist
UnitedHealth Group
Richardson
01.2011 - 01.2015
- Trained all employees on multiple complex adjustments which included closed, denied, and simple adjustments
- Used trends to develop best practices for all claims specialist on daily metrics goals including quality, productivity, and attendance
- Familiar with identifying all products associated with every provider contract
- Demonstrated a full understanding of processing all claims
- Established and maintained successful working relationships with providers and their billing specialist
Clinical Associate Administrative Coordinator
UnitedHealth Group
Schaumburg
01.2010 - 01.2011
- Explained explanation of benefits to members to increase their understanding of their claims
- Partnered with leaders to create more efficient workflows for all employees
- Exceeded established productivity, schedule adherence, and quality goals
- Created prior authorizations for treatment & handle customer material request
- Handled billing and payments while providing excellent customer service
Senior Customer Service Representative
HSBC
Wood Dale
01.2007 - 01.2010
- Delivered world class customer service and build customer loyalty through phone interaction
- Provided effective and timely resolution of a range of customer inquiries
- Lead the team in average handle time and quality for 2 years
- Shared best practices with leaders to improve onboarding of all new employees
- Handled escalated calls from other agents to better resolve customer issues
Education
Bachelors of Arts - Finance
Texas Women University
08-2027
Associates of Arts - Healthcare Administration
American InterContinental University
03.2018
Skills
- OJT Coach
- UNET-Facets-NICE Online Routing System
- Service Improvement Coach/Mentor
- CEP Platform
- Auditing new hires and seasoned team members
- CMS reporting
- Effective written & verbal communication skills
- Billing reimbursement (physician, facilities…)
- Knowledge of ICD9, CPT, or HCPC codes
- Solving complex issues
- OON Programs (SSP, MNRP, ENRP, OCM)
- SME
- Ensured Compliance/Regulatory followed by all new hires (benefits, mandates, and policies
Core Knowledge And Skill Areas
- OJT Coach
- UNET-Facets-NICE
- Online Routing System
- Service Improvement Coach/Mentor
- CEP Platform
- Auditing new hires and seasoned team members
- CMS reporting
- Effective written & verbal communication skills
- Billing reimbursement (physician, facilities...)
- Knowledge of ICD9, CPT, or HCPC codes
- Solving complex issues
- OON Programs (SSP, MNRP, ENRP, OCM)
- SME
- Ensured Compliance/Regulatory followed by all new hires (benefits, mandates, and policies)
Accomplishments
- A/R was reduced by over 6 million dollars for one of the largest children’s hospital in the DFW area
- Worked on the SWHR (Southwestern Health Resources) impacted claims project for 5 facilities located within the DFW area ~ approx. $4 million dollars recouped/saved
- Assisted in the presentation of introducing TX StarPlus program to our contracted providers statewide. Program became effective September 1, 2024.
Timeline
Provider Relations Advocate - Account Manager
UnitedHealth Group
04.2019 - Current
Sr. Claims Business Process Analyst
UnitedHealth Group
04.2017 - 04.2019
SME Provider Reimbursement Representative
UnitedHealth Group
01.2015 - 04.2017
SME-OJT Provider Claim Resolution Specialist
UnitedHealth Group
01.2011 - 01.2015
Clinical Associate Administrative Coordinator
UnitedHealth Group
01.2010 - 01.2011
Senior Customer Service Representative
HSBC
01.2007 - 01.2010
Bachelors of Arts - Finance
Texas Women University
Associates of Arts - Healthcare Administration
American InterContinental University
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