Moriah Paulus
Rosemead,CA
Summary
Highly effective Provider Relations Supervisor and Account Manager with 10+ years of customer service and client facing experience. Offering an array of skills such as cross functional collaboration, relationship management, change implementation and issue resolution.
Overview
14
14
years of professional experience
Work History
Provider Relations Supervisor (ACO)
Astrana Health
Los Angeles, CA
12.2024 - Current
- Partnered with ACO operations to implement initiatives, providing consistent updates on progress and challenges.
- Established and nurtured relationships through routine visits to provider offices.
- Guided team members through mentorship and coaching, ensuring peak performance and career advancement.
- Created strategies aimed at retention, growth, and effective marketing practices.
- Engaged with internal teams to facilitate comprehensive program success.
Provider Relations Manager
Astrana Health
Houston, TX
01.2024 - 12.2024
- Assisted with business and network development of Primary Care providers and Specialists through relationship building and contracting efforts.
- Built and maintained new and existing provider relationships.
- Conducted provider onboarding, orientation and ongoing educational training to ensure providers remain compliant with specified programs and various regulations.
- Worked closely with other departments (both internally and externally) to ensure provider inquiries are resolved in a timely manner.
- Provided detailed reporting to provider offices to ensure transparency surrounding various measurements as CAHPS, STARS, coding/quality.
- Managed performance in various incentives based and/or value based programs.
Provider Engagement Representative
CareAllies/Cigna
Houston, TX
08.2021 - 01.2024
- Developed and maintained positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value based programs.
- Served as the primary point of contact for providers and their staff to assist in contract management and provide supporting analyses for network and performance optimization.
- Prepared and delivered presentations with providers, provider staff, and/or physician leadership during operational meetings.
- Ensured that root cause analyses were performed to identify a resolution related to provider concerns, grievances, claims and care delivery.
- On a daily basis developed, tracked, monitored and reported on key program performance metrics, such as utilization, coding, and STARs/quality performance to ensure compliance.
- Created and delivered materials to educate providers and their staff on contracts, policies and procedures, quality and service line initiatives, and financial performance.
Associate Account Manager
HealthHelp
Houston, TX
03.2021 - 08.2021
- Contributed towards building and maintaining strong and lasting relationships with decision makers and key stakeholders within client organizations, driving client satisfaction, and ensuring renewals.
- Helped Identify new revenue opportunities from existing clients, creating proposals; responsible to the run the framing process to closure. Assisting with contractual documents.
- Analyzed data independently to discover insights and trends that drive recommendations for clients.
- Ensured all required reports are delivered to the client in a timely manner.
- Maintained current industry knowledge of healthcare trends and issues.
- Reached out to clients to strengthen relationships and drive value.
- Analyzed program processes and makes recommendations for improving efficiency, resulting in expense reduction both internally and for external clients.
- Responsible for production, quality assurance and distribution of monthly and/or quarterly cost savings and utilization customer reports (external).
- Developed specific corrective action plans (CAPs) for any programs and/or services with subpar performance.
Market Communication and Account Manager
HealthHelp
Houston, TX
01.2018 - 02.2021
- Maintained Client invoicing
- Created and translates client-specific processes between non-technical and technical partners and clients
- Ensured that managed team members deliver a high customer service experience and that the team members are meeting monthly deliverables
- Provided account management for US Imaging vendor
- Strategized and implements various projects, coordinating efforts across various departments
- Identified client needs and implements process improvements to enhance client experience and provide high levels of efficiency
Network Relations Consultant
HealthHelp
Houston, TX
06.2014 - 01.2018
- Onboarded new employees through NEO (New Employee Orientation).
- Educated and trained providers on HealthHelp's expanding portfolio of products for greater program participation.
- Reviewed adhoc reports for accuracy and trends to identify opportunities for growth and improvement.
- Maintained and built relationships with managed clients and providers across the nation.
- Prepared and conducted regularly scheduled conference meetings to address service delivery expectations, delivery outcomes, education and issue resolution.
- Analyzed data for quarterly utilization and trend reports that are reported to Client Market/Regions.
- Fostered relationship with Directors, Vice Presidents, Medical Directors and others leaders to ensure a high level of visibility and customer service.
- Conducted weekly calls with C-Suite executives to provide transparency into program/provider performances.
- Consistently identified and improves interdepartmental communication.
- Ensured accuracy of all change requests.
Provider Relations Consultant
HealthHelp
Houston, TX
05.2013 - 06.2014
- Collaborated cross functionally to identify areas of improvement opportunities for multiple payers.
- Performed outreach to identified provider offices to address program compliance issues.
- Addressed questions/issues from providers and assisted with claim denial resolution.
Customer Service Representative
HealthHelp
Houston, TX
09.2011 - 05.2013
- Conducted administrative intake and scripted calls for clinical review.
- Provided quality customer service through interactions with providers, administrative staff and others.
- Collected and entered confidential information ensuring the highest level of confidentiality.
- Assisted in the orientation and training of new Client Service Representatives in department procedures, protocols and administrative tasks.
Education
Bachelor's Degree - Healthcare Business Management
Western Governors University
Houston, Texas09.2020
Associates Degree - Healthcare Administration
University of Phoenix
Houston, Texas06.2013
High School Diploma - undefined
Opportunities for Learning
Lancaster, California05.2008
Skills
- Microsoft Office Suite - Expert
- Customer Service - Expert
- Customer Relationship - Experienced
- Management WebEx - Expert
- Salesforce - Expert
- Mondaycom - Expert
- Conflict Resolution - Expert
- Communication and Presentation - Expert
LINKS
https://www.linkedin.com/in/moriah-villalobos-488869a2
Timeline
Provider Relations Supervisor (ACO)
Astrana Health
12.2024 - Current
Provider Relations Manager
Astrana Health
01.2024 - 12.2024
Provider Engagement Representative
CareAllies/Cigna
08.2021 - 01.2024
Associate Account Manager
HealthHelp
03.2021 - 08.2021
Market Communication and Account Manager
HealthHelp
01.2018 - 02.2021
Network Relations Consultant
HealthHelp
06.2014 - 01.2018
Provider Relations Consultant
HealthHelp
05.2013 - 06.2014
Customer Service Representative
HealthHelp
09.2011 - 05.2013
Bachelor's Degree - Healthcare Business Management
Western Governors University
Associates Degree - Healthcare Administration
University of Phoenix
High School Diploma - undefined
Opportunities for Learning