Summary
Overview
Work History
Education
Skills
Timeline
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Maureen Dougherty

Macungie,PA

Summary

Results-driven Provider Engagement Consultant with expertise in fostering strong provider relationships and enhancing provider satisfaction. Proven ability to drive strategic initiatives that improve network performance and compliance. Skilled in healthcare data analysis, provider education facilitation, and cross-functional collaboration to achieve organizational objectives.

Overview

8
8
years of professional experience

Work History

Payroll Specialist

ADP
Allentown, PA
09.2023 - Current
  • Calculated earnings from timesheets to determine federal withholding tax deductions based on 11+ government regulations.
  • Introduced a new tracking system for an HR project that led to a 35% reduction in payroll processing costs.
  • Prepared and processed the monthly payroll for 19 or more senior staff members.
  • Distributed checks at the end of each pay period to over 1,200 employees using ADP Payroll software.
  • Assisted with internal and external audits by providing accurate payroll data and documentation.

Provider Engagement Consultant

Capital BlueCross
Harrisburg, PA
06.2021 - 08.2023
  • Managed a database of 230+ providers, maintaining up-to-date credentialing information, and ensuring timely renewals.
  • Streamlined provider enrollment process, which reduced enrollment time by 20%, allowing providers to bill and provide services more efficiently.
  • Resolved any conflicts between payers and providers regarding preauthorization, claims adjudication issues, through timely negotiations and communication within network management department guidelines.
  • Developed and executed training programs for new credentialing staff, resulting in a 20% increase in team efficiency.
  • Analyzed provider performance metrics, utilization patterns, and quality data to support strategic discussions and drive improvements.

Insurance Follow-Up Representative

Lehigh Valley Hospital
Allentown, PA
10.2020 - 06.2021
  • Conducted timely and thorough follow-up on outstanding insurance claims to ensure maximum reimbursement.
  • Utilized EMR systems (e.g., Epic, Cerner, Meditech), and payer portals to track claim status and update account information.
  • Exceeded monthly performance metrics, including days in accounts receivable, and claim resolution rates.
  • Reduced aged accounts receivable by 30% within six months through proactive claims follow-up, and denial resolution.
  • Maintained a 95% accuracy rate in claim documentation and payer communication audits.

Server

BJ's Brewhouse
Allentown , PA
11.2017 - 03.2020
  • Assisted the management team with a menu restructure to promote food items with the highest margin, resulting in an increase in sales of 20%.
  • Exceeded sales targets by 10% by upselling menu items and drinks based on the specific tastes and interests of diners.
  • Assisted co-workers during rush-hour periods by taking extra customer orders and bringing out prepared dishes.
  • Trained six server staff members based on best practices, and provided feedback to junior staff to improve customer satisfaction.
  • Managed close-out procedures on weekends for servers to ensure that tips were properly distributed.

Education

Bachelor of Science - Healthcare Administration

Western Governors University
Salt Lake City, UT
06-2022

Skills

  • Attention to Detail
  • Time Management
  • Verbal & Written Communication
  • MS Office Suite
  • Analytical Skills
  • Conflict Resolution
  • Team Collaboration
  • Adaptability
  • Customer Service
  • Problem Solving

Timeline

Payroll Specialist

ADP
09.2023 - Current

Provider Engagement Consultant

Capital BlueCross
06.2021 - 08.2023

Insurance Follow-Up Representative

Lehigh Valley Hospital
10.2020 - 06.2021

Server

BJ's Brewhouse
11.2017 - 03.2020

Bachelor of Science - Healthcare Administration

Western Governors University

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Maureen Dougherty