PATRICIA ESTRADA

Bachelor of Arts Degree in Health Care Administration/Management - St. Mary’s College of California Results oriented with experience as a Senior Provider Network Development Manager, Provider Relations Liaison-Network Manager with Anthem CareMore, a Medicare Advantage, Anthem Blue Cross, a Medi-Cal HMO and Patient Account Representative for TENET hospitals. Working in collaboration with IPA’s, Health Plans, Providers, and Hospitals while developing strong Relationship Building and Collaborative skills. Contracting, Credentialing, Onboarding. educating, training and evaluation of Providers. Resolve provider issues with claims and members. Patient Advocate regarding their Grievances and Appeals, Billing issues. Revenue Cycle Specialist performing billing and reimbursement follow-up for six TENET facilities, including Appeals and Claim Issues resolution. Excellent presentation, communication, organizational and problem-solving skills; Solid track record of consistently meeting and exceeding company goals and objectives. Knowledgeable of HIPAA and CMS guidelines; UM, CAQH, CAHPS, HOS, HCC, RAF, CPT, ICD. Conducted HEDIS Pursuits. Risk Adjustment, Customer Service oriented.

 I have a Registered Therapy Dog, who I take to visit with patients and families, at the local Hospice House, Nursing Homes, and Hospitals.