Pamela Betti
Commack,NY
Summary
To work within the health care arena as a Manager/Senior Provider Relations Representative or a position in a related field.
Professional in provider relations with solid background in building and maintaining network partnerships. Strong focus on team collaboration and delivering results, adaptable to changing needs. Skilled in conflict resolution, communication, and strategic planning. Known for reliability and effective relationship management.
Overview
21
21
years of professional experience
Work History
Network Manager
LIBERTY Dental Plan
08.2016 - Current
- Assist providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Strengthen provider networks through regular outreach and relationship building activities.
- Serve as a liaison between healthcare organizations and insurance companies to ensure seamless communication regarding claims processing and payment matters.
- Manage high-volume caseloads of dispute resolution cases, providing swift resolutions that maintained positive relationships with both parties involved.
- Research and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings.
- Optimize operational workflows by identifying inefficiencies in current procedures and implementing necessary adjustments for increased productivity.
- Answer provider inquiries via email, telephone and written correspondence.
- Foster strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Assist with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
- Identify network gaps and collaborated with recruiters to fill deficiencies.
- Initiate physician and hospital orientations to support ongoing education of health care provider community.
- Organize and participated in provider workshops, seminars, and meetings to foster ongoing engagement with network partners.
- Provide exceptional customer service when working directly with healthcare professionals, establishing a reputation as a trusted resource for assistance.
Provider Relations Representative
Fidelis Care New York
02.2004 - 02.2015
- Served as a liaison between healthcare organizations and insurance companies to ensure seamless communication regarding claims processing and payment matters.
- Strengthened provider networks through regular outreach and relationship building activities.
- Assisted providers in navigating through various reimbursement processes, resulting in timely payments and reduced financial disputes between parties.
- Managed high-volume caseloads of dispute resolution cases, providing swift resolutions that maintained positive relationships with both parties involved.
- Participated in cross-functional teams tasked with improving overall performance metrics within the organization''s Provider Relations department.
- Conducted regular audits of provider records, identifying discrepancies and ensuring accuracy in information.
- Developed comprehensive training materials for new Provider Relations Representatives, facilitating a smooth transition into their roles.
- Presented at industry conferences to represent company interests while expanding professional knowledge on best practices in Provider Relations management.
- Reduced claim disputes by effectively communicating policy changes and updates to providers.
- Resolved customer complaints using established follow-up procedures.
- Answered provider inquiries via email, telephone and written correspondence.
Education
BS - Health Sciences
Hunter CUNY
New York, NY01.1990
Skills
- Network troubleshooting
- Claims reviewing
- Team leadership
- Health plan operations
Timeline
Network Manager
LIBERTY Dental Plan
08.2016 - Current
Provider Relations Representative
Fidelis Care New York
02.2004 - 02.2015
BS - Health Sciences
Hunter CUNY
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