Stephanie Carter
Provider Performance Enablement
Forney,TX
Summary
Seasoned Provider Relations Representative possessing in-depth knowledge of various insurance plans and policies. Well-versed in medical claim appeal processing, clinical relations and medical billing. Expertise in handling high volume of calls, efficiently resolving disputes and identifying ways to improve processes. Proficient in HEV, TruCare, Facets and OneGuide. Communicative and detail-oriented individual with excellent interpersonal abilities.
Overview
9
9
years of professional experience
8
8
years of post-secondary education
1
1
Certification
Work History
Provider Performance Enablement
Cigna
Plano, TX
05.2022 - Current
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Developed, reviewed and prepared STARs, Part D and HEDIS provider education material, increasing efficiencies in processes YOY.
- Initiated physician and hospital orientations to support ongoing education of health care provider community.
- Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
Case Management Analysis
Cigna
Plano, TX
03.2017 - 04.2021
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
- Fostered professional networks and relationships with service and resource providers to promote continuity and quality of care for clients.
- Tracked employees before, during and after training to verify attainment of training objectives.
- Delivered in-house training sessions to existing employees to roll out new processes, rules and technologies.
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion.
Customer Service Representative
Century Healthcare
The Colony, TX
05.2014 - 03.2017
- Assisted patients in understanding how insurance coverage works and calculated copays.
- Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
- Answered inbound calls from existing and future policyholders to answer inquiries and discuss limited indemnity plan insurance options.
- Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
Education
High School Diploma -
Beecher High School
Flint, MI 09.1998 - 05.2002
Associate of Science - Health Administration
Brookhaven College
Dallas, TX 01.2019 - Current
Skills
Provider relationship management
Workflow Analysis
Educational Presentations
Health plan operations
Report preparation
Complaint resolution
Staff education and training
Written and oral communication
Key Performance Indicator development
Performance assessment
Affiliations
- Toastmasters
Certification
Certified Preceptor, Cigna - 2018-2021
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
I believe you have to be willing to be misunderstood if you're going to innovate.
Jeff Bezos
Timeline
Provider Performance Enablement
Cigna
05.2022 - Current
Associate of Science - Health Administration
Brookhaven College
01.2019 - Current
Certified Preceptor, Cigna - 2018-2021
02-2018
Case Management Analysis
Cigna
03.2017 - 04.2021
Customer Service Representative
Century Healthcare
05.2014 - 03.2017
High School Diploma -
Beecher High School
09.1998 - 05.2002