Summary
Overview
Work History
Education
Skills
Languages
References
Timeline
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Senaida Tapia

East Wenatchee,WA

Summary

Results-driven professional with a proven track record of delivering quality work. Exceptional communication and teamwork abilities to achieve company goals and provide exceptional service. Committed to continuous learning and professional development.

Overview

28
28
years of professional experience

Work History

Provider Relations Specialist

Health Alliance NW & Confluence Health
04.2022 - Current
  • Assist providers with different stages of the Revenue Cycle.
  • Resolve conflicts with providers and payers through effective communication strategies.
  • Facilitate provider engagement through the coordination of activities, such as seminars, conferences, and workshops.
  • Ensure prompt resolution of all Provider Relations-related inquiries from both internal personnel and external clients.
  • Ensure compliance with HIPAA regulations in managing provider records.
  • Facilitated meetings scheduled on a routine basis to brief healthcare providers about regulatory changes and updates.
  • Developing and maintaining relationships to ensure patient care quality.
  • Review provider contracts for compliance with laws and regulations.
  • Engage in interdepartmental projects focused on enhancing the visibility of network providers' services.
  • Facilitate dispute resolution processes between payers and providers, utilizing effective problem-solving techniques.
  • Maintain professional relationships with healthcare providers and facilities in Chelan, Douglas, Okanogan, and Grant counties.
  • Demonstrated exceptional ability to stay composed in pressure-packed circumstances, utilizing interpersonal skills to ease tensions.
  • Worked alongside internal departments like Compliance, Legal, and Finance in cases of requirement.

Senior Claims Adjudicator

Confluence Health
Wenatchee, WA
10.2000 - 03.2022
  • Evaluated incoming insurance claims to establish valid corresponding policy.
  • Addressed inconsistencies in claim details by seeking clarification from providers.
  • Ensured accurate claims adjudication through comprehensive research of policy language, relevant laws, and regulations.
  • Promoted member satisfaction by responding promptly to questions regarding claim status or coverage issues.
  • Effective management of workflow through prioritization of urgent tasks.
  • Performed data entry into the system following established guidelines.
  • Evaluated appeals submitted by members and providers seeking reconsideration of denied claims.
  • Collaborated with colleagues across different departments, fostering teamwork and shared goals.
  • Conducted comprehensive investigations of suspicious claims with a focus on ensuring quality, thoroughness and cost-effectiveness.
  • Advised management on potential areas of improvement in the claims process.
  • Collaborated with other departments to resolve complex claims.

Lead Business Assistant

Columbia Valley Community Health
10.1996 - 10.2000
  • Organized and maintained company files and records, ensuring accuracy and confidentiality.
  • Prepared agendas and made arrangements for meetings, conferences, teleconferences.
  • Coordinated travel arrangements for staff members when needed.
  • Answered incoming calls from members in a professional manner to address inquiries or complaints.
  • Managed the reception area by greeting visitors in a friendly manner.
  • Provided administrative support to all departments within the company.
  • Generated purchase orders for office supplies as needed.
  • Attended events on behalf of the organization when necessary.
  • Answered phones and transferred callers to relevant departments and staff members.
  • Implemented effective organizational methods for creating and maintaining filing systems.
  • Enhanced productivity through effective coordination of scheduling, task prioritization, and process streamlining.
  • Identified internal problems, recommending solutions to upper management.
  • Maintained positive working relationship with fellow staff and management.
  • Displayed strong telephone etiquette, effectively handling difficult calls.

Education

Skills

  • Analytical Problem Solving
  • Effective Conflict Resolution
  • Healthcare Provider Training
  • Proficient in Computer Applications
  • Provider relationship management
  • Multitasking
  • Adaptability and Flexibility
  • Detail-Oriented Approach
  • Revenue Cycle
  • Provider Contracting
  • Provider Network Development
  • Effective Relationship Development
  • Claims Processing Expertise
  • Interpersonal Communication
  • Time management abilities
  • Task Prioritization
  • Self-Funded and Commercial Plan knowledge
  • Medicaid Health Plan Knowledge
  • Medicare Plan Knowledge
  • Epic Tapestry Software
  • Provider Fee Schedule Management
  • Fluent in English and Spanish

Languages

Spanish
Native/ Bilingual

References

References available upon request.

Timeline

Provider Relations Specialist

Health Alliance NW & Confluence Health
04.2022 - Current

Senior Claims Adjudicator

Confluence Health
10.2000 - 03.2022

Lead Business Assistant

Columbia Valley Community Health
10.1996 - 10.2000

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Senaida Tapia