Maria Silva
Pittsburg,CA
Summary
A highly adaptable and results driven- professional transitioning into a Provider Contracting role, confident in taking on new challenges while utilizing established strengths. Demonstrated excellence in collaboration, adaptability and critical thinking to enhance provider engagement. Exceptional problem-solving abilities and interpersonal skills, with a focus on continuous quality improvement, and customer satisfaction.
Overview
7
7
years of professional experience
Work History
Quality Specialist II
Health Net, Centene
03.2020 - Current
- Monthly HEDIS focused Provider outreach.
- Collaborate with cross-functional departments as needed.
- Supported Facility Review committee to review applications prior to credentialing.
- Participated in continuous quality improvement initiatives
- Drafted reports such as Performance Indicator Report and annual NCQA reporting.
- Conducted data review, trend analyses and identified opportunities for improvement.
- Conducted annual After Hours survey for access reporting.
- Annual Policy Management, review and approve changes made for Policy renewal.
- Managed purchase orders via Coupa system.
- Quarterly Hospital Acquired Condition outreach to facilities.
- Monthly Pregnant member Letter outreach, to promote services and doula benefits.
- HOS, IMMH SME
Provider Network Administrator
MHN, a Health Net
04.2019 - 03.2020
- Assisted with physician recruitment by identifying specific Single Case Agreement providers within designated territories, negotiating rates and distributing provider agreements.
- Engaged Providers to provide critical information.
- Helped address Provider complaints through timely and appropriate referrals.
- Answered provider inquiries via email, telephone
- Monitored MHN Provider Portal, to support and grant access to end users.
- Identified and immediately resolved network issues.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate regional Rep.
- Devised scripts and automation tools to improve system efficiency.
- Researched and addressed Business Solution Requests about Provider demographic changes.
- Managed updates to Provider files timely for Provider Directory accuracy as needed.
- Assisted in researching and resolving Potential Administrative Issues.
- Processed Provider Resignations.
Customer Service Representative
Kelly Services
12.2018 - 06.2019
- Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
- Identified network gaps and collaborated with team to fill deficiencies.
- Researched and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction
- Responded to Provider rate increase requests.
Health Information Analyst
InGenesis
05.2018 - 12.2018
- Responsible for recruitment of Medicated Assisted Treatment Providers, within the designated TRICARE West Territory.
- Identified network gaps and collaborated with colleague to fill in deficiencies.
- Answered provider inquiries related to contract, via email, and telephone.
- Applied administrative knowledge and courtesy to explain reimbursement procedures to Providers.
- Collaborated with credentialing team to process applications.
- Distributed provider agreements.
Education
Vocational Certificate - Med. Administrative Assistant & Billing/Coding
Contra Costa Medical Career College
Antioch, CAAssociate of General Studies -
Diablo Valley College
Pleasant Hill, CA01-2007
Skills
- Adaptability
- Attention to detail
- Customer satisfaction, Call center experience
- Problem-solving, and critical thinking skills
- Collaboration and teamwork skills
- Microsoft Excel, Outlook, Teams
- Excellent Communication and interpersonal skills
- Time Management
- Compliance and regulation knowledge
- Analytical skills
- Knowledge of healthcare systems
Languages
Spanish
Timeline
Quality Specialist II
Health Net, Centene
03.2020 - Current
Provider Network Administrator
MHN, a Health Net
04.2019 - 03.2020
Customer Service Representative
Kelly Services
12.2018 - 06.2019
Health Information Analyst
InGenesis
05.2018 - 12.2018
Vocational Certificate - Med. Administrative Assistant & Billing/Coding
Contra Costa Medical Career College
Associate of General Studies -
Diablo Valley College
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