Ronnie Winn
Phoenix,AZ
Summary
Enthusiastic, critical thinking and eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Training in multiple roles within healthcare systems. Motivated to learn, grow and excel.
Overview
12
12
years of professional experience
Work History
Provider Contract Specialist
Blue Cross Blue Shield Of Arizona
Phoenix, United States
09.2021 - Current
- Using strong negotiation skills, contract with healthcare providers on Single Case Agreements.
- Understand and interpret various analyses of financial structure of contracts to ensure it meets financial targets.
- Work closely with Legal to ensure that contract language can be administered and compliant with corporate guidelines.
- Update and maintain contracting documents, ensuring compliance with legal, regulatory and compliance guidelines.
- Consult and coordinate with various internal departments, external Blue Plans or business partners, providers, business entities.
- Identify, research, process, resolve and respond to provider claims and payment inquiries associated with Single Case Agreements.
- Front to back development for No Surprise Act Federal Mandate implementation. Process development for intake, monitoring and provider messaging.
- Worked closely with legal to ensure compliance for No Surprise Act Federal Mandate.
- Effectively trained and manage team of 7 contractors to facilitate intake and processing of open negotiation request to adhere to No Surprise Act Federal Mandate.
- Coordinated with internal business partners to submit offers to Independent Dispute Resolution Entities under No Surprise Act Federal Mandate.
Government Programs Project Associate Advisor
Banner Health
Phoenix, AZ
01.2021 - 09.2021
- Disseminates CMS regulatory, sub-regulatory and policy guidance in a timely manner and receives verification and documentation that such guidance is strictly adhered to and implementation verified. Independently reviews evidence of implementation and advises functional areas and leadership o veracity of evidence.
- Preform QA audits on all regulatory reports from partnering departments.
- Timely submissions of all required regulatory reports for Arizona Cost Containment and Long Term Care contracts.
- Maintain high volume shared email box for all communications from internal partners and regulators.
- Updating media materials for monthly Regulatory Oversite meetings.
- Maintaining an internal SharePoint database of upcoming regulatory reporting and policy updates.
- Acknowledgment and resolution of AHCCCS provider complaints.
- Cross trained in multiple lines of business for Medicare and Medicaid compliance.
Senior Network Management Specialist
Magellan Complete Care Of Arizona
Phoenix, AZ
05.2019 - 12.2020
- Assisted in the implementation of Network. This includes recruiting providers in the assigned geographical service area, tracking progress of Network build and implementing processes and workflows.
- Recruiting individual, group and/or organizational providers to meet network adequacy standards and assure quality network.
- Contracting all providers approved for Network participation.
- Conducts and coordinates contracting and amendment initiatives.
- Credentialing existing and new providers.
- Tracking all contract requests, Single Case Agreements and Terminations.
- Provide issue resolution and complex trouble shooting for providers.
- Claims resolution
- Supports provider representatives with data management and general provider request via shared email box.
- Training all new hires on processes and workflows in the Network Department.
- Creating processes and streamlining workflows for multiple departments.
Senior Care Worker Utilization Management
Magellan Complete Care Of Arizona
Phoenix, AZ
08.2018 - 05.2019
- Provide non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
- Receive provider calls and fax notifications requesting authorization for acute and elective medical services.
- Obtain and enter relevant notification, clinical data, appropriate codes, and established benchmarks for authorization’s length of stay.
- Conduct prior authorization research for claim resolution.
- Monitored team workload and turnaround times.
- Assisted in training new Utilization Management employees.
- Development of workflow processes
- UAT System testing
Claims Resolution Specialist
Magellan Health
San Diego, CA
12.2014 - 07.2018
- Research and resolve escalated claims issues involving benefit verification, authorizations, ICD-10, revenue codes and bill types.
- Stop payments and reissuing provider or member payments.
- Provided resolution follow up with all members and or providers to ensure customer satisfaction.
- Developed desktop guides to assist Member Services in first call resolution of multiple common call types.
- Implemented processes regarding accurate member eligibility with the roll out of the Affordable Care Act.
- Acted as a Subject Matter Expert in client shared systems
- User acceptance testing (UAT) Handle Provide re-enforcement training for new associates as required as well as on-floor support for existing associates.
- Consistently met turnaround times for provider disputes.
Customer Service Associate
United Healthcare Group
San Diego, CA
01.2013 - 04.2014
- Handled high volume specialty medications requests, orders, and additional assistance.
- Maintained above average customer service goals for call-time, off call work, and customer service volume.
- Managed projects for policy and procedures documentation in accordance with company initiatives.
- Continuously lead team-specific goals for all aspects of customer service.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Maintained accurate and current customer account data with manual forms processing and digital information updates.
Shared Services Specialist
University of Phoenix
Phoenix, AZ
11.2009 - 01.2013
- Researched program and industry information that best adheres to potential student's needs.
- Handled high-volume outbound and inbound customer service needs of potential students.
- Answered and aided potential and current students' academic needs and request.
- Completed numerous data entry projects with adhering to time sensitive matters with minimal mistakes.
Skills
- Adaptability
- Communication
- Customer Service
- ICD-10
- Microsoft Office Suite
- JIRA software
- Government policy compliance
- SharePoint
- Sales Force
- Negotiation
Timeline
Provider Contract Specialist
Blue Cross Blue Shield Of Arizona
09.2021 - Current
Government Programs Project Associate Advisor
Banner Health
01.2021 - 09.2021
Senior Network Management Specialist
Magellan Complete Care Of Arizona
05.2019 - 12.2020
Senior Care Worker Utilization Management
Magellan Complete Care Of Arizona
08.2018 - 05.2019
Claims Resolution Specialist
Magellan Health
12.2014 - 07.2018
Customer Service Associate
United Healthcare Group
01.2013 - 04.2014
Shared Services Specialist
University of Phoenix
11.2009 - 01.2013
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