Megan Saul
Asbury,IA
Summary
Professional with experience in provider relations and strong track record of optimizing communication between healthcare providers and organizations. Skilled in conflict resolution, contract negotiation, and relationship management. Focused on team collaboration and achieving results, adapting to changing needs, and ensuring seamless coordination. Employers value reliability, effective communication, and strategic thinking.
Overview
17
17
years of professional experience
Work History
Provider Relations Coordinator, promoted to Sr. Provider Relations Coordinator
Medical Associates Clinic & Health Plans
07.2012 - Current
- Participate in negotiations with contracted Providers, Provider System Offices and/or their Consultants on new contracts, amendments or other necessary changes to contracts
- Administer contracting and re-contracting process adhering to requirements of MAHP, Centers for Medicare and Medicaid (CMS) and National Committee for Quality Assurance (NCQA), as well as state and federal laws; maintain schedule of renewals and facilitate timely completion of re-contracting; evaluate and monitor provider contract performance; create and communicate fees/fee schedules to configuration, other internal team members and external contacts as appropriate
- Create models based upon past utilization to estimate impact of fee schedule or other contract changes; request or create adhoc reports as needed relative to contracted and non-contracted providers, stop-loss carriers, national wrap networks or re-pricing networks
- Act as primary contact person for Contracted Network Providers relative to issues relating to contract terms or issues that cannot be resolved within Member Services/Claims; establish and maintain relationships with contracted network office staff; respond to contract issues from Providers and/or Internal Team.
- Contributed to the development of annual departmental goals and objectives, actively working towards their achievement through focused efforts and collaboration.
- Tracked key performance indicators to measure success of campaigns.
- Developed comprehensive training materials for new Provider Relations Coordinators, ensuring a smooth onboarding process.
- Conducted regular provider audits to ensure compliance with company policies and industry regulations.
- Enhanced provider relationships by consistently addressing concerns and resolving issues in a timely manner.
- Collaborated with network development teams to identify potential new providers, expanding the organization''s reach and services offered.
Configuration Specialist II
Medical Associates Clinic & Health Plans
11.2007 - 06.2012
- Configure and maintain claims adjudication subsystems as necessary to maximize accuracy and efficiency of claims payment, along with maintenance of non-core business systems (ie: HIPAA EDI, web tools)
- Ability to work with end users to train, assist, guide and resolve problems
- Maintain a friendly, respectful, and professional work environment for all user/external contacts
- Ability to analyze configuration and reconfiguration issues
Education
Bachelor of Science - Biology, Psychology
University of Dubuque
Dubuque, IA12.2001
Skills
- Medical terminology
- Contract development
- Oral and written communication
- Cost efficiency
- Contract management
- Application development
- Customer-oriented
- Decision-making skills
- Strong listening skills
- Great eye for detail
- Staff motivation
- Excellent spelling skills
- External communications
- Strong interpersonal skills
- Microsoft Office
- Strong problem solver
- Data analysis and research
- Deadline-oriented
- Dedicated team player
- Current Procedural Terminology (CPT)
- Healthcare industry
- Customer support
- Provider network management
- Network configuration
- Configuration auditing
- Workflow Analysis
- Provider relationship management
- Provider orientations
- Fee exception negotiations
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Reliability
- Excellent communication
- Organizational skills
Accomplishments
- Collaborated with several Health Systems to develop a network of providers.
Leadership Experience
Team Manager for Dubuque Soccer Club Girls Team, 3 years
Languages
English
Full Professional
Timeline
Provider Relations Coordinator, promoted to Sr. Provider Relations Coordinator
Medical Associates Clinic & Health Plans
07.2012 - Current
Configuration Specialist II
Medical Associates Clinic & Health Plans
11.2007 - 06.2012
Bachelor of Science - Biology, Psychology
University of Dubuque
Similar Profiles
Jodi DacarJodi Dacar
Account Sales Executive/ Client Consultant -Hybrid at Health Alliance Medical Plans, IncAccount Sales Executive/ Client Consultant -Hybrid at Health Alliance Medical Plans, Inc
Crystal DjordjevicCrystal Djordjevic
Point of Service Auditor/Educator at Health Alliance Medical PlansPoint of Service Auditor/Educator at Health Alliance Medical Plans
Karri DavisKarri Davis
Provider Relations Specialist at Health Alliance Medical PlansProvider Relations Specialist at Health Alliance Medical Plans
Baluku Moris MwahulhwaBaluku Moris Mwahulhwa
Part-time Assistant Lecturer at Kyambogo UniversityPart-time Assistant Lecturer at Kyambogo University
Oscar TelschowOscar Telschow
Student Teacher at Southwestern SchoolsStudent Teacher at Southwestern Schools