T.A Hughes
Greensboro,NC
Summary
Experienced Senior Provider Relations Advocate with a proven track record in effective negotiation strategies and complex problem-solving. Adept at fostering strategic business relationships while maintaining compliance and delivering exceptional service.
Overview
11
11
years of professional experience
Work History
Senior Provider Relations Advocate
United Healthcare
06.2024 - 11.2025
- Negotiated reimbursement amounts with healthcare providers to benefit consumers referred to Naviguard.
- Researched claims and reconciled Out-of-Network payment histories to develop effective negotiation strategies.
- Collaborated with internal teams to gather background information for negotiations and share outcomes.
- Tracked and documented negotiations, ensuring timely follow-up and resolution with providers and consumers.
- Led provider engagement initiatives to enhance collaboration and communication across healthcare networks.
- Developed and implemented strategies to improve provider satisfaction and retention rates.
- Served as Subject Matter Expert (SME) for team processes, contract workflows and decicated provider groups
Network Contract Manager
United Healthcare
09.2022 - 06.2024
- Led contract negotiation processes, ensuring compliance with legal standards and organizational policies.
- Developed comprehensive contract management strategies to optimize supplier relationships and mitigate risks.
- Streamlined contract review procedures, enhancing accuracy and reducing turnaround times for approvals.
- Mentored junior staff in best practices for contract administration and risk assessment techniques.
- Analyzed vendor performance metrics to inform strategic decision-making and improve contract terms.
- Collaborated cross-functionally with stakeholders to align contract objectives with business goals.
- Developed strong relationships with clients and vendors, fostering mutually beneficial partnerships.
Senior Patient Advisor
United Healthcare
02.2021 - 09.2022
- Engage directly with consumers to provide support and guidance on complex claim issues (high dollar or escalated cases), gather appropriate information, and maintain ongoing communications with consumers until the identified issue has been resolved
- Provide mentoring support for new Advisors released from new hire training
- Research complex billing and claims issues across multiple systems, identify and complete root cause analysis, and partner with internal and external support resources to drive resolution
- Assist in user acceptance testing for system enhancements and new technology launches
- Led strategic initiatives to enhance member engagement and satisfaction across healthcare programs.
- Served as Subject Matter Expert (SME) for team
- Conduct NSA quality audits for Advisors and Sr. Advisors
Service Led Navigator
United Healthcare
04.2019 - 02.2021
- Provide members with one point of contact to share guidance on clinical and service needs.
- Creating personalized member navigation, treatment and recovery Plans via phone
- Experience addressing a variety of problems and issues as presented by callers
- Experience working flexibly and creatively with other professional team members
- Experience working with a culturally and geographically diverse population
- Provide seamless coordination of holistic health management in alignment with the care plan of treating provider
- Provide concierge services to support and guide members through the complexities of the healthcare system.
- Educate members on available community based resources, benefits and services
Advocate 4ME
United Healthcare
05.2015 - 04.2019
- Applies knowledge/skills to a range of moderately complex activities.
- Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
- Demonstrates great depth of knowledge/skills in own function.
- Determine member eligibility and benefit coverage as appropriate
- Provide solution focused consultation to assist member with issue resolution
- Served as Subject Matter Expert (SME) for team and dedicated group plan
- Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
- Proactively identifies solutions to non-standard requests.
- Solves moderately complex problems
- Plans, prioritizes, organizes and completes work to meet established objectives.
Education
MBA - Healthcare management
American InterContinental University
Schaumburg, Illinois03-2018
Bachelor of Science - Psychology minor Criminal Justice
Chowan University
Murfreesboro, NC05.2010
Skills
- Proficient in Microsoft Office tools
- Dispute resolution
- Time management and problem-resolution skills
- Efficient in data entry
- Negotiation strategies
- Reimbursement protocols
- Provider relations
- Healthcare compliance
- Customer relationship management
- Experienced working with Centers for Medicare & Medicaid Service (CMS) regulations and guidelines
- HIPAA Compliance
- PHI handling
- Project management
- Team collaboration
- Complex problem solving
- Mentoring and training
- Provider network development
- Strategic business relationships
- Process analysis
Timeline
Senior Provider Relations Advocate
United Healthcare
06.2024 - 11.2025
Network Contract Manager
United Healthcare
09.2022 - 06.2024
Senior Patient Advisor
United Healthcare
02.2021 - 09.2022
Service Led Navigator
United Healthcare
04.2019 - 02.2021
Advocate 4ME
United Healthcare
05.2015 - 04.2019
MBA - Healthcare management
American InterContinental University
Bachelor of Science - Psychology minor Criminal Justice
Chowan University