Stephanie M. Summers
Rockwall
Summary
Detail-oriented professional with extensive experience in healthcare management, specializing in provider relations and strategic project management. Proven track record of enhancing network composition and resolving provider claim issues, fostering positive relationships between health plans and providers.
Overview
28
28
years of professional experience
Work History
Senior Provider Advocate Account Manager
UnitedHealthcare
07.2015 - Current
- Currently I am a Senior Provider Advocate Account Manager for the Central Division servicing multiple markets.
- We direct and implement strategies relating to the development and management of a provider network.
- Identified gaps in network composition and services, supporting network contracting and development staff in prioritizing contracting needs.
- Managed end-to-end provider claim issues, ensuring timely resolution and effective communication.
- Identified and remediated operational shortfalls while researching and resolving claims.
- We design and implement programs to build and nurture positive relationships between the health plan, providers, and practice managers.
BIA Analyst
UnitedHealthcare
08.2014 - 07.2015
- Analyzed healthcare data to identify trends and support decision-making processes.
- Collaborated with cross-functional teams to develop strategic business initiatives.
- Performed audits by developing processes, processing claims, and grading audits to confirm compliance with plan benefits.
- Retested audits to ensure timely and accurate completion of changes requested by auditors.
- Conducted comprehensive research on market conditions and competitive landscape.
Various Positions
UnitedHealthcare
Plano
12.2006 - 03.2014
- In the past 4 years I have held many positions under the direction of Transaction Operations.
- I have been a Project Manager where I was able to successfully manage multiple on-going projects at a time.
- Achieved multiple successes as Project Manager, resulting in promotion to Supervisor.
- I have played a key role in working on the Health Care Reform initiatives for a smooth transition for all Transaction teams.
- Oversaw a team of 21 members, ensuring effective collaboration and productivity.
- I managed the Regulatory Review Group team and ensured compliance with all projects.
- Supervised the Closed & Denied team and History Conversion until the restructure and their transition to another team.
- Enhanced daily metrics and vital signs scores through implementation of new policies.
- Facilitated transition to VEPS program and integrated offshore workers to manage inventory.
- I also held a position as an Intake Manager for the PCND team.
- Coordinated projects from beginning to end.
- I make sure all projects stay on task and are completed timely and accurately per the SOPs.
- I also served as a Market Service Agent where I worked with Providers and Network Managers to resolve complex rework issues and bring them to a satisfactory conclusion.
Manager
UnitedHealthcare
Plano
04.2006 - 12.2006
- I was the Manager for the Americhoice Team.
- Monitor and motivate team to reach and surpass our goals and metrics.
- Managed all human resource issues, including timesheets, one-on-ones, and conflict resolution.
- Ran daily reports on team stats, aligning performance with management parameters.
- Coordinated training on policies and procedures for new hires.
- Facilitated procurement of team member IDs, hardware, and essential supplies.
- Work on multiple project groups, including North Carolina DOI reports where I drill down to find and report root causes of claims problems.
Supervisor
UnitedHealthcare
Plano
04.2005 - 04.2006
- Led new hire training classes to onboard and integrate new employees into the organization.
- Coordinated new hire classes, developed curriculum, and ensured timely completion of all assignments.
- Scheduled daily training and conducted approximately 25% of the training while mentoring team members.
- Daily quality audits on phone, online routing system and defects and coach on how to maintain and boost production.
- Ran reports for team and provided feedback on previous day's phone results to enhance team performance.
- Must perform one on one meetings with my team members including disciplinary action.
- Managed multiple projects for Manager and other Supervisors to ensure alignment and efficiency.
- Perform weekly, monthly, quarterly and yearly audits and reports for upper Management.
Customer Advocate
UnitedHealthcare
Plano
09.2002 - 04.2005
- In my role as a Customer Advocate, I handled 70+ Major, Key and Public Sector Accounts.
- Answered high volume of emails, faxes, and phone calls, ensuring timely and accurate responses.
- Implemented new cases and managed setup process from initiation to completion.
- Participated in AMT meetings, addressing escalated issues for internal customers.
- I have traveled to attend Customer Meetings, Health Fairs and do most of the IDT Demo Presentations for Customers and in Finalist Meetings.
- I mentored team members on system issues and customer organization.
- Participated in multiple work groups and Vital Signs groups within the team and collaborated with Six Sigma teams to create better workflow processes.
- Managed spreadsheet projects using Excel to ensure data accuracy and organization.
Customer Service and Claims
UnitedHealthcare
Plano
03.1998 - 09.2002
- Leveraged extensive background in claims processing, focusing on provider contracts, care coordination, and customer service.
- I processed claims from the Que, ORS and paper adjustments.
- Started role in customer service and claims processing.
- Trained and supervised new hires in CRG staging area, facilitating effective onboarding and team integration.
- Managed staging area for new hires within CRG team, ensuring smooth onboarding and integration.
- Provided temporary supervision for customer service team to ensure operational continuity.
Education
High School Diploma -
Abundant Life Private School
Garland, TX03-1998
References
References provided upon request.
Affiliations
- CASA, Court Appointed Child Advocate
Timeline
Senior Provider Advocate Account Manager
UnitedHealthcare
07.2015 - Current
BIA Analyst
UnitedHealthcare
08.2014 - 07.2015
Various Positions
UnitedHealthcare
12.2006 - 03.2014
Manager
UnitedHealthcare
04.2006 - 12.2006
Supervisor
UnitedHealthcare
04.2005 - 04.2006
Customer Advocate
UnitedHealthcare
09.2002 - 04.2005
Customer Service and Claims
UnitedHealthcare
03.1998 - 09.2002
High School Diploma -
Abundant Life Private School