Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nicole Cuneo

Pflugerville,Texas

Summary

Professional Provider Relations and Billing Specialist with over 20 years of experience developing effective relationships with providers and negotiating contracts. Proven ability to provide consistent, high level customer service while meeting organizational objectives in a faced paced environment.

Overview

20
20
years of professional experience

Work History

Senior Provider Network Specialist

Ameita
08.2020 - Current
  • Answered provider inquiries via email, telephone and written correspondence.
  • Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
  • Act as a liaison between Medicaid Providers and MHP, ensuring smooth communication and resolution of any issues
  • Research, address, and resolve provider requests, questions, and concerns regarding claims, authorizations, fee schedule, and credialtialing
  • Provide clear and actionable resolutions, offering root cause analysis for provider inquiries
  • Stay updated with Amerita website education materials, basic portal knowledge, and problem-solving resources to support providers
  • Educate providers on policies, procedures, and billing processes related to Medicaid
  • Maintain a thorough understanding of Medicaid programs and regulations to ensure accurate and timely support for providers
  • Utilize available resources to perform thorough research and assist providers with timely solutions
  • Ensure all customer requests are handled effectively, maintaining high customer satisfaction
  • Meet all contractual obligations while fostering positive interpersonal relationships with program participants
  • Participate in scheduled meetings and events on time, managing time efficiently throughout the workday
  • Communicate consistently with internal teams, external providers, associations, and stakeholders about Amerita policies and processes
  • Support ongoing efforts to improve the provider experience and resolve technology or process-related frustrations when necessary
  • Complete tasks and assignments in a timely manner while maintaining professionalism and a strong work ethic

Lead Provider Account Manager

Option Care-BioScrip
03.2012 - 07.2020
  • Expertise in physician/facility/ancillary contract reimbursement methodologies
  • Lead cross functional teams and drive the team to successfully complete the objectives
  • Engage with local provider organizations to support, augment and accelerate efforts to improve operational coordination of patient care
  • Assist with contracts, credentialing, letter of agreements, and one time case agreements
  • Research and proactively seek to fill in knowledge gaps in key functional areas Provide/ensure training to applicable audiences, as needed
  • Ensure project documentation is accurate and all projects are completed on time and within scope
  • Managed a diverse portfolio of accounts, ensuring timely communication and effective problem resolution.
  • Analyze project outcomes and make appropriate recommendations to improve outcomes/processes moving forward
  • Collect/synthesize best practices from across a network of provider organizations Meet and / or exceed client service level provider relations expectations
  • Manage provider relationships that require frequent contact; includes large, regional and complex clients Document activities and report on progress, utilizing tools and job aids as requested by manager, on a consistent, timely and accurate basis

Hospital Business Office Manager

San Ramon Regional Hospital
09.2005 - 02.2012
  • Managed financial operations for the business, ensuring accurate budgeting and timely invoice processing.
  • Updated reports, managed accounts, and generated reports for company database.
  • Resolved financial discrepancies and customer billing issues with timely attention.
  • Enhanced customer satisfaction by addressing inquiries promptly and resolving issues professionally.
  • Coordinated staff schedules, adjusting workloads to maximize productivity and meet deadlines.
  • Supported the growth of the business through targeted marketing initiatives and client outreach efforts.
  • Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
  • Conducted performance evaluations for employees, identifying areas for improvement and providing constructive feedback.
  • Fostered a positive work environment by resolving staff conflicts promptly and promoting open communication.
  • Implemented employee training programs, increasing overall staff competency and reducing skills gaps.

Education

Bachelor of Science - Health Care Administration

Dillard University
New Orleans, LA
08-1995

Bachelor of Science - Nursing

Southern University And A&M College
Baton Rouge, LA
08-1993

Skills

  • Project Management
  • Attention to detail
  • Customer Service
  • Problem Solving
  • Multi-tasking
  • Time Management
  • Attention to Detail
  • Network security management
  • Credentialing
  • Billing
  • Claims
  • Authorizations

Timeline

Senior Provider Network Specialist

Ameita
08.2020 - Current

Lead Provider Account Manager

Option Care-BioScrip
03.2012 - 07.2020

Hospital Business Office Manager

San Ramon Regional Hospital
09.2005 - 02.2012

Bachelor of Science - Health Care Administration

Dillard University

Bachelor of Science - Nursing

Southern University And A&M College

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Nicole Cuneo