Summary
Overview
Work History
Education
Skills
Timeline
Generic

Maureen Roe Mullin

Sunrise,FL

Summary

Experienced Provider Relations Advocate with over 20 years in healthcare management, specializing in provider relations, claim operations, and service interactions. Proven track record in establishing policies, coordinating with business partners, and leading complex projects. Adept at hosting educational events, analyzing financial data, and recommending operational improvements.

Overview

27
27
years of professional experience

Work History

Senior Physician Advocate

United Healthcare
07.2014 - Current
  • Establish and implement standard policies, procedures and best practices across Claim Operations to promote compliance with contractual obligations.
  • Led a portfolio of complex claim projects and contract settlements for large health systems with 600+ providers.
  • Planned and executed large scale educational events across Florida, offering CEUs to contracted providers; successfully organized logistics, speaker coordination and registration for events with 200+ attendees.
  • Coordinate with internal business partners to ensure agreed upon provider specified requirements are met.
  • Organized financial data and completed reports detailing key metrics for our contacted providers.
  • Recommended and implemented operational improvements through data tracking and performance analysis, resulting in a 36% decrease in call volume.
  • Mapped process activities to desired outcomes to rectify operational inefficiencies.
  • Serve as a resource to contracted providers for Commercial, Medicare and Medicaid line of business.
  • Identified process inefficiencies through gap analysis.
  • Identified and pursued valuable business opportunities to improve bottom line profit.
  • Work with delegated entities (internal and external) to ensure problems consistently resolved.

Small Business Sales Account Consultant

United Healthcare
01.2013 - 07.2014
  • Responsible for the customer's total service experience with UnitedHealthcare.
  • Served as the key liaison between the customer and the Central Service team.
  • Managed the trending/monitoring of service issue resolution, and education for the customer and their employees.
  • Conduct training/education with customers on UnitedHealth Care eServices, Reporting, and other eTools as appropriate.
  • Responsible for conducting open enrollment meetings or coordinating coverage with other offices.
  • Responsible for training customers on UnitedHealthcare's core wellness tools and resources, as well as communicating various administrative/service-related changes to the customer (i.e.; network or pharmacy preferred drug changes).

Physician Advocate

United Health Group
01.2011 - 01.2013
  • Accountable for full range of provider relations and service interactions within United Health Group.
  • Worked end-to-end with providers on claims or other inquiries.
  • Educated physician offices on training portal, future service enhancements and development of external provider education programs.
  • Design and implement programs to build and nurture positive relationships between the health plan and providers (physicians, hospitals, ancillary, etc.).
  • Identify gaps in network composition and services to assist the network contracting in prioritizing contracting needs.

Supervisor Provider Relations, Neighborhood Health Partnership Segment

United Healthcare
08.2005 - 01.2011
  • Managed the Provider Services Team, including Provider Relations Representatives, In-House Coordinator, Provider Contract Management and other Provider associates.
  • Monitored team activities to assure the staff met performance standards and operated effectively and efficiently.
  • Produced reports on departmental metrics.
  • Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.
  • Monitored staff workload and made recommendations on distribution of work.
  • Provided coaching and training to direct reports.
  • Promoted positive relationships with the provider community.
  • Interfaced with all other departments to ensure appropriate configuration of contracts, reimbursement rates, benefits and to address claims and operational issues.
  • Participated in standing meetings as necessary.
  • Monitored provider complaints and made recommendations to Directors and Vice President for addressing provider issues.

Provider Relations Representative

Memorial HealthCare System
10.2001 - 04.2004
  • Visited and assisted providers contracted with Memorial’s IPA.
  • Frequented offices and trained Office Managers and staff on new policies and procedures with the IPA.
  • Performed Site Visits to ensure each office complied with HIPPA and MHS standards.

Provider Relations Representative

Tenet Health
10.1998 - 10.2001
  • Organized monthly meetings with IPA groups to manage and ensure policies and procedures are followed by each physician practice.
  • Visited and assisted providers contracted with Tenet’s IPA.
  • Maintained monthly excel spread sheet listing all physicians requiring site visits for myself and other team members.
  • Assisted provider offices with any claim/authorization issues.

Education

Palm Beach State College
Lake Worth, FL

Skills

  • Microsoft Applications
  • ISET
  • CSP Facets
  • NDB
  • Salesforce Impact
  • Salesforce Spire
  • Salesforce ACET
  • Insights
  • UNET

Timeline

Senior Physician Advocate

United Healthcare
07.2014 - Current

Small Business Sales Account Consultant

United Healthcare
01.2013 - 07.2014

Physician Advocate

United Health Group
01.2011 - 01.2013

Supervisor Provider Relations, Neighborhood Health Partnership Segment

United Healthcare
08.2005 - 01.2011

Provider Relations Representative

Memorial HealthCare System
10.2001 - 04.2004

Provider Relations Representative

Tenet Health
10.1998 - 10.2001

Palm Beach State College

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