Hi, I’m
Paula Ironside
Mount Vernon,IA
Summary
Accomplished Network Account Manager, with over 25 years experience in the Health Insurance Industry. Proven expertise in Network Relations. Comprehensive background in claims processing, and workflow efficiencies. Skilled experience in providing quality customer service and problem solving. Self motivator with demonstrated ability in multitasking and time management. Mediated vendor relationships with both internal and external personnel and network affiliates. Outstanding organizational skills, flexibility and prioritization
Overview
14
years of professional experience
Work History
Aetna, a CVS Health Company
Network Relations Manager
10.2017 - Current
Job overview
- Develop and manage high performance networks
- Investigate and respond to complex provider related issues
- Subject matter expert for provider relations activities
- Coordinated with internal teams to facilitate prompt delivery of provider projects.
- Mentor Junior staff members
- Partner with and responsible for over 40 hospitals, ancillary facilities and provider clinics
- Skilled at working independently and collaboratively in team environment
- Proven ability to learn quickly and adapt to new situations
- Managed time efficiently in order to complete all tasks within deadlines
Coventry Health Care
Sr. Provider Relations Representative
07.2012 - 10.2017
Job overview
- Building and Maintaining positive relationships with network providers
- Updated, proofed provider directories, using Salesforce
- Research and resolves incoming escalated provider inquiries
- Assist with development and implementation of provider training programs
- Participate in initiatives identified through NCQA, HEDIS, and other quality improvement programs
- Partner with internal network and operational areas to identify and resolve root causes of on-going and repetitive claim issues
- Assist in developing materials and communication for provider education
- Involved with training and mentoring new Provider Relations Representatives
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Participated in team projects, demonstrating ability to work collaboratively and effectively
Principal Financial Group
Network Service Representative
01.2009 - 01.2012
Job overview
- Facilitate prompt and accurate customer claims within PPO network by providing assistance with complex issues
- Serve as liaison between claims staff, other network teams, PPO, PPO ancillaries and specialty networks
- Research and resolve questions related to PPO fee schedules, contractual provisions, administrative policies and procedures from various claim service centers
- Conduct research of claims reconsideration and all other reporting to isolate issues with network claim payment accuracy
- Responded to provider concerns with friendly and knowledgeable service and remedied issues promptly and effectively.
- Partner with internal network and operational areas to identify and resolve root causes of on-going and repetitive claim issues
- Provide supportive assistance to Provider Records department by loading PPO provider demographic and contract data
- Assist claims support area in gathering, consolidating, and analyzing data involving large-volume claim reviews
Education
Kirkwood Community CollegeCedar Rapids, IA
Skills
- HIPPA Fundamentals & HIPPA Privacy & Acknowledgement
- Excellent Communication Skills
- Fair Claims Practices
- Prioritizing Workflows
- Microsoft Excel Microsoft Office
- Training New Team Members
- Provider Relationship Management
- Healthcare Fraud
- Records Management
Timeline
Network Relations Manager
Aetna, a CVS Health Company
10.2017 - Current
Sr. Provider Relations Representative
Coventry Health Care
07.2012 - 10.2017
Network Service Representative
Principal Financial Group
01.2009 - 01.2012
Kirkwood Community College
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