Nancy Mena
Whittier,CA
Summary
Self-motivated Data Analyst offering 20 plus years of skilled collaboration experience across various departments. Methodical with significant experience in data mining and statistical analysis. Excellent problem-solver with history automating processes and driving operational enhancements.
Overview
24
24
years of professional experience
Work History
Sr Provider Data Analyst for MarkerCARES Central Region Team
UnitedHealth Group of California
Telecommuter, CA
01.2021 - Current
- Submit PhyCon submission and follow-up on request
- Load contractual and demographical information into ProBase and NICE
- Execute contracts and amendments in CLM
- Complete items received via IMPACT on a timely manner
- As a Hybrid Loader
- Responsible for researching, resolving, and loading issues regarding contractual and demographical by correcting and adding data into the NDB database
- Communicate effectively with NAM’s and CAT team
- Run Danner and Amaardi Reports.
Provider Data Analyst for MarkerCARES West Region Team
UnitedHealth Group of California
Telecommuter, CA
01.2020 - 01.2021
- Load contractual and demographical information into ProBase and NICE
- Execute contracts and amendments in CLM
- Complete RESCU items received via PhyCon and IMPACT on a timely manner
- Super Loader
- Responsible for researching, resolving and loading issues regarding contractual and demographical by correcting and adding data into the NDB database
- Communicate effectively with NAM’s and CAT team.
Provider Data Analyst for CAT West Region Team
UnitedHealth Group of California
Telecommuter, CA
01.2016 - 01.2020
- Super Loader
- Responsible for researching, resolving and loading issues regarding contractual and demographical by correcting and adding data into the NDB database
- Execute contracts and amendments in Emptoris
- Complete RESCU items received via PhyCon on a timely manner
- Communicate effectively with NAM’s and CAT team
- Trained to handle Triage items into PhyCon.
Network Contracting Associate Provider Installation Specialist for PCNM Team
UnitedHealth Group of California
Cypress, CA
01.2011 - 01.2016
- Responsible for terminations in all the United States regions as they relate to contractual issues
- Responsible for submitting terms requested, and auditing all applicable term systems, such as NDB, NICE, PROBASE, ILIAND, DIAMONDS, PULSE/OXFORD and FACETS
- Insured all have been properly termed to avoid potential problems such as claims issues
- Responsible for handling any escalated issue coming from all sources, such as Network Management, Legal or Sanctioned request coming from Clinic Ops
- Responsible for submitting requests and sending letters to keep our members informed of providers or Groups no longer contracted in our network.
Provider & Network Execute and Maintenance Associate for PCND Team
UnitedHealth Group of California
Cypress, CA
01.2008 - 01.2011
- Responsible for physician contract execution
- Emptoris Contract loading into the database
- Non-Emptoris contract submissions for all legacy platforms
- Contracting maintenance including and not limited to amendments, physicians add/term or tin change to all contract types (Non MGA).
Term and Credentialing Liaison, PPO Physician Contracting and Operations
PacifiCare of California
Cypress, CA
01.2007 - 01.2008
- Responsible for all of California, Washington, Oregon and Southeast Region terms as it relates to contractual issues
- Was the credentialing Liaison for the operational department
- Responsible for terming individuals and groups due to non-conformity with rates or other contractual issues
- Responsible for terming all providers that have sanctions against them
- Handle credentialing issues such as non-compliant, delegated status, interested providers, and non-responsive.
Provider Relations Associate, PPO Physician Contracting and Operations
PacifiCare of California
Cypress, CA
01.2005 - 01.2007
- Responsible for submitting provider’s up-date submission such as terms, add providers to group, provider tin changes and any type of demographic changes, to insure proper information is display on our nation wide database
- Responsible for such submissions for all Northern California providers
- Initiated any claim re-work for providers
- Responsible for maintaining an open and professional attitude as a representative of this organization with our providers.
Associate Information Coordinator I, PPO Physician Contracting and Operations
PacifiCare of California
Cypress, CA
01.2004 - 01.2005
- Responsible for phones supporting more than 25 employees including the PPO provider line
- Responsible of starting the contracting process of interested providers by sending them contracting packages
- Researched correct mailing address for returned contracts of providers by mail
- Maintained accurate information for the begging part of the contracting process of each individual physician in provider care database
- Accountable for sending and storing already executed and scanned individual physicians contracts, to Iron Mountain.
Clerical Associate III, Direct Physician HMO and PPO Physician Contracting and Operations
PacifiCare of California
Cypress, CA
01.2002 - 01.2004
- Responsible for phones supporting in excess of 35 employees including the PPO Provider Line (back up)
- Coordinated physician meetings, invitation mail/fax out, RSVP line, fulfillment of packets for meetings, and shipping
- Assisted project managers in excel spreadsheet projects
- Provided assistance to administrative assistant in support of department tasks including but not limited to, reconciliation of department credit card statements, and scheduling of meetings
- Proficient in PacifiCare Operating platforms (PC 100, PC 130 and RIMs) to support information gathering regarding projects and physician calls (in an effort to triage appropriately).
Clerical Associate III, PPO Physician Contracting and Operations
PacifiCare of California
Cypress, CA
01.2000 - 01.2002
- Managed contract process flow; responsible to complete and submit contract summaries, obtained credentialing information from provider necessary to successfully complete credentialing process (submit and track credentialing status), responsible to send counter-signed contracts with manual to provider at the conclusion of the contract process
- Proficient in RIMs to determine physician contract status.
Skills
- Contracting
- Delivery Coordination
- Provider Support
- Project Planning
- Data Entry
- Healthcare Knowledge
- Customer Expectation Management
- Data Collection
- Effective Listening And Communication
- Progress Documentation
- Relationship Management
- Knowledgeable In NDB, NICE, Probase, CLM, CMD, Orbit, Emptoris, Predict
- Proficient in Windows, Mac Literate, Excel/Word/Outlook/OneNote
Languages
Spanish
Professional
Timeline
Sr Provider Data Analyst for MarkerCARES Central Region Team
UnitedHealth Group of California
01.2021 - Current
Provider Data Analyst for MarkerCARES West Region Team
UnitedHealth Group of California
01.2020 - 01.2021
Provider Data Analyst for CAT West Region Team
UnitedHealth Group of California
01.2016 - 01.2020
Network Contracting Associate Provider Installation Specialist for PCNM Team
UnitedHealth Group of California
01.2011 - 01.2016
Provider & Network Execute and Maintenance Associate for PCND Team
UnitedHealth Group of California
01.2008 - 01.2011
Term and Credentialing Liaison, PPO Physician Contracting and Operations
PacifiCare of California
01.2007 - 01.2008
Provider Relations Associate, PPO Physician Contracting and Operations
PacifiCare of California
01.2005 - 01.2007
Associate Information Coordinator I, PPO Physician Contracting and Operations
PacifiCare of California
01.2004 - 01.2005
Clerical Associate III, Direct Physician HMO and PPO Physician Contracting and Operations
PacifiCare of California
01.2002 - 01.2004
Clerical Associate III, PPO Physician Contracting and Operations
PacifiCare of California
01.2000 - 01.2002
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