Tonya Barton
Plainfield,IL
Summary
Results-driven Provider Relations Representative with proven ability to complete tasks efficiently and productively. Specialize in network development, contract negotiation, and issue resolution, ensuring smooth operations within healthcare networks. Excel in communication, problem-solving, and relationship-building, leveraging these soft skills to foster strong connections with providers and enhance service quality.
Overview
10
10
years of professional experience
Work History
Provider Relations Coordinator- Remote
Innovista Health
Remote
01.2021 - 05.2024
- Coordinate provider relations activities, including education, reporting, and network development. Assure compliance with respective contracts.
- Provide input on policy development, particularly around the Medicare Shared Savings Program and other risk-sharing programs, and provide direction and training to all providers in the network
- Oversee daily network operations in collaboration with the Market leadership and Medical Management teams, reinforcing action plans for both the network and individual providers
- Collaborate with Market leadership on provider performance measures, communication, and satisfaction surveys. Ensure provider directories are accurate.
- Aid in the creation and implementation of provider training programs, handle complaints from providers and members and anticipate provider needs for proactive issue resolution
- Cultivate and maintain professional relationships within the healthcare community, including hospitals, physician offices, ancillary providers, and contracted health plans
Remote Senior, Provider Relations Executive- Provider and Community Servicing
NextLevel Health Partners
Chicago, IL
04.2019 - 01.2021
- Responsible for proactive support of plan providers and staff including orientation, education, and the scheduling of on-site visits as well as incorporating plan's policies and procedures and for fostering a positive perception of the plan among providers
- Established and fostered strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and identifying on-site enrollment opportunities
- Assist in the coordination of NCQA compliant site audits of Primary Care Providers
- Addressed and resolved provider issues regarding reimbursement, proper utilization of policies and procedures, billing and coordination of resolution through provider education
- Assist in yearly assessing and planning of NLP participation in various community events and social media presence.
- Handled grievances submitted on an urgent basis until satisfied with providers and health plans.
Senior, Provider Relations Representative (Field base & Remote)
Wellcare/Harmony(Meridan) Healthcare Plans
Chicago, IL
06.2016 - 04.2019
- Focused on raising company STARS and HEDIS measures by educating providers on open care gaps
- Accountable for educating PCP and Specialty providers on company policies, procedures, payment structures
- Conduct monthly face-to-face meetings as SME within specific geographic area with the provider and hospitals account representatives and research claims issues on-site, where possible, and route to the appropriate party for resolution
- Conducted site visits to service providers, provider orientations, resolve issues, educate staff/providers on policies, collect credentialing information, and ensure locations are up to MCO standard
- Supports network improvement by providing stakeholders with utilization, ER Frequent flyer, membership, monthly roster, redetermination reports, and financial reports and provide other important information from HFS, and Health plan
- Provides solutions with Medicaid and CMS requirements around provider contracting, credentialing, loading, and terminations
- Project management lead.
Provider Relations Specialist, Networking Liaison
CHS/Tenet
Westmont, IL
10.2014 - 09.2016
- Participated in Quarterly Provider forums, Shareholder and Board meetings
- Maintained Provider manual and PHO policies as directed from Board director
- Scheduled and conducted weekly field visits with providers and office managers
- Organized and conducted portal orientation for new and existing providers and offices
- Worked with providers and office staff to ensure compliance with PHO's requirements and expectations
- Maintained & Terminated provider or participant access to any CHS systems completing provider exit interviews to see how we can do better as a company
- Worked with leadership to develop and implement many departmental protocols
Education
Bachelor's in Healthcare Management -
University of Phoenix
01.2017
Skills
- 15 years of provider relations healthcare experience
- Team Leadership
- Excellent Communication
- Client Relationship Management
- Health plan operations
- Claims reviewing
- Educational Training & Development
- 10 plus years Salesforce, EzCap, EzNet, Workday, Kimedics
- Excellent time management and priority setting skills
Timeline
Provider Relations Coordinator- Remote
Innovista Health
01.2021 - 05.2024
Remote Senior, Provider Relations Executive- Provider and Community Servicing
NextLevel Health Partners
04.2019 - 01.2021
Senior, Provider Relations Representative (Field base & Remote)
Wellcare/Harmony(Meridan) Healthcare Plans
06.2016 - 04.2019
Provider Relations Specialist, Networking Liaison
CHS/Tenet
10.2014 - 09.2016
Bachelor's in Healthcare Management -
University of Phoenix
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