Tina Heverling
Manheim,PA
Summary
Healthcare professional with proven track record in provider relations, bringing valuable experience in facilitating smooth interactions between providers and healthcare entities. Known for collaborative approach and results-driven mindset, consistently meeting dynamic needs of team and organization. Skilled in conflict resolution and process improvement, with focus on delivering high-quality service.
Overview
9
9
years of professional experience
1
1
Certification
Work History
PROVIDER RELATIONS REPRESENTATIVE
naviHealth/Optum
06.2022 - Current
- Managing provider Network for multiple states, based on Home Health, Medicare Advantage members
- Design and implement education for providers, data analysis, member support and clinical outreach
- Analyzing provider performance, reimbursement arrangements, and credentialing activities
- (NDB)
- Identify gaps in network composition and assist providers, while creating positive and ongoing relationship
- Successfully attended and delivered work instructions for the department.
CLINICAL ADMINISTRATIVE COORDINATOR
Optum
05.2021 - 06.2022
- Various administrative tasks to better daily operations of department, coordination of care and life activities for members, share resources with patients
- In collaboration with management creating new advanced work instructions to better serve patient population.
PATIENT SERVICES REPRESENTATIVE
Triwest Healthcare Alliance
02.2018 - 05.2020
- Representing veteran’s patient population
- Reviewing medical records for medical necessity
- Creating, education and supporting patient population, providers, and training staff, in compliance and governmental changes
- Problem resolution partner in creating better solution for veterans’ population healthcare delivery.
INSURANCE SPECIALIST/MEDICAL ASSISTANT
Diamantoni & Associates Family Practice
09.2015 - 02.2018
- Performed all duties of medical assistant, triage nursing, EKG, vitals, education and Holter Monitor
- While also preforming insurance specialist duties, administrative support, letters of medical necessity, claims, medical record reviews, office supplies order, insurance verification coverage, billing, and coding.
Education
Associate degree - Allied Healthcare
Harrisburg area Community College
06.2010
Skills
- Provider Relations
- Clinical documentation review
- Letters of Medical Necessity
- Insurance Authorizations- Prior Authorization Process
- Credentialing/ Medicare certification
- Electronic Medical records (Epic, Athena Health)
- National Data Base – proficient user
- Power point presentation and public speaking
- Microsoft office
- Salesforce
- Tableau/Orbit
- Data Analysis
- Project Management
- Customer Service
- Knowledge of multiple Governmental Administration Protocols
- Provider support
Certification
- Certified Professional Coder AAPC 2020, May
Timeline
PROVIDER RELATIONS REPRESENTATIVE
naviHealth/Optum
06.2022 - Current
CLINICAL ADMINISTRATIVE COORDINATOR
Optum
05.2021 - 06.2022
PATIENT SERVICES REPRESENTATIVE
Triwest Healthcare Alliance
02.2018 - 05.2020
INSURANCE SPECIALIST/MEDICAL ASSISTANT
Diamantoni & Associates Family Practice
09.2015 - 02.2018
Associate degree - Allied Healthcare
Harrisburg area Community College
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