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Nancy Ryan Smith
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Summary
Results-driven Senior Provider Relations Representative skilled in provider network management and dispute resolution. Improved operational efficiency and reduced billing errors through precise contract interpretation and proactive engagement. Fostered strong relationships and ensured compliance with regulatory standards, facilitating continuous improvement across multi-specialty networks.
Overview
29
29
years of professional experience
Work History
Senior Provider Relations Representative
Providence Health Plans
Portland, OR
03.1997 - Current
- Serve as primary liaison for physicians, hospitals, and provider offices, delivering training and ongoing support to improve workflow efficiency and reduce operational friction.
- Manage recruitment, onboarding, and ongoing maintenance of a large, multi-specialty provider network, supporting multiple lines of business and ensuring network adequacy standards are met.
- Resolved high volume of complex provider inquiries on billing, reimbursement, and contract interpretation, ensuring accurate claim outcomes and reducing repeat issues.
- Interpret contract language and reimbursement methodologies, reducing billing errors, clarifying expectations, and preventing escalations.
- Led resolution of escalated provider disputes by identifying root causes and implementing corrective actions, enhancing provider experience and decreasing recurrence.
- Build and sustain long-term provider relationships through consistent follow-through, proactive communication, and successful issue resolution.
- Trained provider office staff and internal partners on workflows, policies, and utilization management processes, promoting adoption and enhancing operational consistency across teams.
- Ensure compliance with CMS and NCQA standards, supporting audit readiness and regulatory adherence across the provider network.
- Collaborate cross-functionally with internal teams to resolve complex issues, improving coordination and reducing delays impacting providers.
Education
Bachelor of Science - Sociology, Black Studies, Speech
Portland State University
Portland, ORSkills
- Provider Network Management
- Contract Interpretation
- Reimbursement Analysis
- Claims Resolution
- Dispute Management
- Escalation Management
- Utilization Management Support
- Regulatory Compliance
- Provider Training
- Provider Education
- Cross-Functional Collaboration
- Process Improvement
- Workflow Optimization
- Provider Engagement
Accomplishments
- Values In Action Award
Timeline
Senior Provider Relations Representative
Providence Health Plans
03.1997 - Current
Bachelor of Science - Sociology, Black Studies, Speech
Portland State University