Summary
Overview
Work History
Education
Skills
Timeline
Generic

Prisma I. Hernandez

Spring,TX

Summary

Experienced in managing providers and adept at building and maintaining network partnerships. Skilled in conflict resolution, communication, and known for reliability and determination. Committed to advancing professional career by utilizing abilities to expand knowledge and excel in role. Eager to collaborate with a company that prioritizes professional growth.

Overview

15
15
years of professional experience

Work History

Provider Relations Representative

Innovista Health Solutions
09.2019 - Current
  • Served as a liaison between healthcare insurance and providers to ensure seamless communication regarding claims processing, payment matters and quality metric goals.
  • Strengthened provider education regarding Annual Wellness Visits requirements, including HCC forms.
  • Brought in a couple of new providers to participate in Accountable Care Organization, ensuring compliance and optimal performance in Quality Gap reports.
  • Maintain and build positive relationships with all 35 assigned providers/ practices.
  • Ensure timely, accurate distribution and revision of all necessary standard reports for assigned practices.
  • Support assigned ACO's / IPA's by coordinating meeting venues, business meals and meeting minutes during Board meetings and JOCs.
  • Assisting practices in establishing access to payor portals and any issues as needed.
  • Assisted with physician recruitment by identifying specific providers within designated territories and distributing provider agreements.
  • Developed educational trainings for internal departments across the organization with participating providers.
  • Downloading reports and filtered as needed to distribute to assigned providers.

Scheduling Coordinator, Authorization Specialist, Receptionist

ARTURO BRAVO MD.
09.2016 - Current
  • Scheduling Coordinator (Current), Authorization Specialist
  • Receptionist (Front desk)

Receptionist

BEST ROW LAND & CLEARING INC.
02.2014 - 05.2016
  • Receptionist
  • Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
  • Responded to inquiries from callers seeking information.
  • Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.

Waitress/Cashier

TAQUERIA MICHOACAN MEXICAN RESTAURANT
01.2012 - 08.2013
  • Waitress/Cashier

Salesman/Cashier

THE DISTRICT CLOTHING STORE
10.2010 - 03.2012
  • Salesman/Cashier
  • Increased sales by offering advice on purchases and promoting additional products.

Education

UNIVERSITY OF HOUSTON-DOWNTOWN
01.2022

High School -

ALDINE HIGH SCHOOL
01.2013

Certified Cosmetologist -

Aldine High School
Houston, TX
01.2013

Skills

  • Bilingual- Spanish/English, Communicative, Critical Thinker, Managing Pressure, Problem Solver, Self-initiative Patience with finding solutions and following through

Timeline

Provider Relations Representative

Innovista Health Solutions
09.2019 - Current

Scheduling Coordinator, Authorization Specialist, Receptionist

ARTURO BRAVO MD.
09.2016 - Current

Receptionist

BEST ROW LAND & CLEARING INC.
02.2014 - 05.2016

Waitress/Cashier

TAQUERIA MICHOACAN MEXICAN RESTAURANT
01.2012 - 08.2013

Salesman/Cashier

THE DISTRICT CLOTHING STORE
10.2010 - 03.2012

UNIVERSITY OF HOUSTON-DOWNTOWN

High School -

ALDINE HIGH SCHOOL

Certified Cosmetologist -

Aldine High School

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