Tracy G. Patterson
Houston,Texas
Summary
Dynamic Provider Network Representative with extensive experience at Oscar Health, adept at building strong relationships and resolving complex issues. Proven ability to meet deadlines and work under pressure, leveraging strong organizational skills and expertise in contracts to drive provider performance and enhance service quality.
Overview
29
29
years of professional experience
Work History
Provider Network Representative (Care Guide)
Oscar Health
Houston, Texas
01.2022 - Current
- Work with provider and member services departments to ensure comprehensive, efficient resolution of issues within stated deadlines
- Conduct provider outreach to educate, investigate, advocate and build/maintain positive relationships with our network of healthcare providers
- Handle phone outreach and email communications with providers on a daily basis
- Manage queue work and case load through efficient dashboard management
- Identify, investigate, and resolve issues within determined SLAs
- Demonstrate resilience, grit, and self-motivation in identifying, troubleshooting, and resolving complex provider issues
- Managed member inquiries and resolved issues efficiently
- Delivered education on health benefits and services available
Senior Provider Network Representative
TexanPlus WellCare Health Plans Inc
Houston, Texas
05.2016 - 12.2019
- Developed and maintained effective working relationships with member services department, medical management department and sales/marketing department
- Recruitment of physicians and professional providers in my assigned territory
- Completed new provider orientation for all applicable product lines to educate on policies and initiatives, resolve issues and educate staff/providers
- Drove improvement of provider performance by analyzing, interpreting and communicating utilization and quality metrics
- Assured that all responsibilities are performed consistent with the deliberate plans of the organization
- Complied with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, as defined in the WellCare department policies
Provider Network Representative
Blue Cross Blue Shield of Texas
Houston, Texas
03.2003 - 01.2015
- Recruited and enrolled physicians and professional providers within assigned areas of responsibility
- Ensured assigned physicians and professional providers were informed when changes occurred in Blue Cross Blue Shield of Texas policies and procedures and provided appropriate education/in-service
- Provided orientations, training and continuing policy education to provider office staff, billing staff and referral/precertification area
- Responded to physician and professional provider inquiries in an effective and timely manner and helped with claims resolution and payment problems
- Established and maintained relationships with assigned providers through personal visits, correspondence and telephone calls
Network Support Representative
Blue Cross Blue Shield of Texas
Houston, Texas
03.2001 - 03.2003
- Supported Provider Network Representatives by scheduling and facilitating meetings, tracking information, responding to provider inquiries, answering phones
- Prepared credentialing and re-credentialing grids to ensure accuracy of data entered in physicians and professional provider files
- Assisted providers with information regarding network participation, plan procedures and managed care products
Technical Analyst
Blue Cross Blue Shield of Texas
Houston, Texas
12.2000 - 03.2001
- Supported Provider Network Representatives by updating the internal provider access database (DRMaster) with provider demographic changes, additions and deletions
- Printed monthly rep reports for the Provider Network Representatives to use for provider visitations
- Queried ad hoc reports when requested by Provider Relations staff or Marketing staff
- Queried monthly reports requested by the Provider Relations Director and Senior Representative
Quality Analyst
Blue Cross Blue Shield of Texas
Houston, Texas
12.1997 - 12.2000
- Answered inquiries and resolved issues based on phone calls/correspondence from members, providers and plan sponsors
- Investigated quality of service complaint inquiries pertaining to eligibility and services received from providers, hospitals and responded within mandated Texas Department of Insurance timeframe
- Assisted with special projects as needed
Customer Service Representative
Prudential Healthcare
Sugar Land, Texas
04.1997 - 11.1997
- Managed incoming provider phone calls regarding member benefits and claim inquiries
- Resolved member complaints and problems pertaining to eligibility and services received from providers and hospitals to members’ satisfaction
- Assisted in educating members regarding their health plan benefits
Education
Bachelor of Business Administration -
Delta State University
Cleveland, Mississippi04.1991
Skills
- Contracts
- Meet deadlines
- Work under pressure
- Verbal communication
- Written communication
- Organizational skills
- Independent work
References
- Health Care Service Corporation - Employee Services, (866) 977-7378
- Human Resources Department - Employment Verification, (866) 604-6572
- Dosetta Cavaness Lewis, (361) 442-1634
Timeline
Provider Network Representative (Care Guide)
Oscar Health
01.2022 - Current
Senior Provider Network Representative
TexanPlus WellCare Health Plans Inc
05.2016 - 12.2019
Provider Network Representative
Blue Cross Blue Shield of Texas
03.2003 - 01.2015
Network Support Representative
Blue Cross Blue Shield of Texas
03.2001 - 03.2003
Technical Analyst
Blue Cross Blue Shield of Texas
12.2000 - 03.2001
Quality Analyst
Blue Cross Blue Shield of Texas
12.1997 - 12.2000
Customer Service Representative
Prudential Healthcare
04.1997 - 11.1997
Bachelor of Business Administration -
Delta State University