Yasheka Walker
Dallas,TX
Summary
Provider Relations Specialist with 12 years of experience in healthcare administration, provider enrollment, provider and member services, credentialing and onboarding, ensuring network efficiency and compliance. Proven liaison skills enhance provider performance through effective communication and issue resolution. Expertise in managing credentialing processes, maintaining confidentiality, and improving workflow in collaboration with medical staff.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Sr Clinical Administration Coordinator
United Healthcare
06.2024 - 10.2024
- Responded to incoming calls and emails, delivering required information and addressing inquiries
- Conducted outbound calls to complete patient Health Risk Assessments
- Updated patient demographic information in Electronic Health Record (EHR) systems after each visit or procedure
- Facilitated patient outreach and education regarding available health system resources
- Educated patients on the correct usage of medications, treatments, and follow-up care instructions
- Utilized computer systems effectively to review information and provide accurate responses to callers
- Supported the clinical administration team in maintaining efficient communication with patients
Provider Relations Associate
United Healthcare
02.2021 - 05.2024
- Reviewed and updated provider enrollment applications to ensure accuracy and completeness
- Assisted providers in completing application packages by obtaining necessary documentation
- Conducted verification checks for new provider enrollments following company policies
- Researched and resolved issues related to provider contracts and credentialing requirements
- Processed re-enrollment requests for terminated providers seeking reinstatement
- Facilitated communication between providers and internal departments to streamline processes
Provider Data Specialist- Behavioral Health
United Healthcare
04.2019 - 01.2021
- Maintained and updated provider information, including credentials, specialties, locations, and contracts, in internal databases
- Ensured compliance with regulations such as HIPAA and CMS guidelines, maintaining data accuracy for claims processing and network adequacy
- Collaborated with providers, internal teams, and external agencies to resolve data discrepancies and updates
- Generated and analyzed reports to support decision-making and enhance operational efficiency
- Utilized data management systems, spreadsheets, and healthcare IT tools, including CAQH and credentialing software
- Investigated and resolved issues related to provider enrollment, credentialing, and network participation
Member Services Representative
Blue Cross and Blue Shield of Louisiana
02.2017 - 06.2018
- Delivered superior customer support during peak call periods, consistently surpassing performance benchmarks and aiding in overall operational achievements
- Utilized various software systems to improve call handling efficiency, resulting in reduced customer wait times
- Cultivated robust provider relationships, facilitated network adjustments, and effectively resolved disputes, contributing to a 96% customer satisfaction rating
Patient Access Representative-Ambulatory Center
University Health Hospital
06.2015 - 02.2017
- Maintained the integrity of patient information and medical records, ensuring adherence to HIPAA regulations and safeguarding patient privacy
- Processed patient deductibles and co-payments, providing clear communication regarding financial responsibilities and available payment options
- Verified insurance eligibility, secured necessary authorizations, and meticulously input claim details to streamline billing procedures and support financial operations
FEP Account Advisor I
Blue Cross Blue Shield of Louisiana
02.2014 - 04.2015
- Served as the primary contact for federal employees concerning health benefits, enrollment, and claims
- Provided guidance on FEP policies, coverage options, and eligibility requirements
- Assisted with billing inquiries, premium payments, and account adjustments
- Addressed and resolved customer concerns related to claims, benefits, and provider networks
- Maintained accurate records and documentation of customer interactions
- Collaborated with internal teams to ensure timely issue resolution
- Educated members about available healthcare programs and wellness initiatives
- Ensured compliance with federal and company regulations regarding health insurance plans
- Participated in training programs to stay updated on FEP policies and industry changes
Education
Bachelor of Science - Health Care Administration
Charter Oak State College
05-2025
Associate of Art - Humanities
Southern University at Shreveport
12.2023
Skills
- Provider management systems (eg, CAQH, Availity)
- CRM tools (eg, Salesforce, Pecos)
- Claims processing software (eg, Facets, Epic, NextGen)
- Proficiency in MS Office Suite (Word, Excel, PowerPoint)
- Data analysis and reporting tools (eg, Tableau, Power BI)
- Time management
- Documentation and recordkeeping
- Microsoft Access
- Verbal and written communication
- Relationship building
- Office administration
- Attention to detail
Certification
Certified Provider Credentialing Specialist, Charter Oak State College, 12/2024
Timeline
Sr Clinical Administration Coordinator
United Healthcare
06.2024 - 10.2024
Provider Relations Associate
United Healthcare
02.2021 - 05.2024
Provider Data Specialist- Behavioral Health
United Healthcare
04.2019 - 01.2021
Member Services Representative
Blue Cross and Blue Shield of Louisiana
02.2017 - 06.2018
Patient Access Representative-Ambulatory Center
University Health Hospital
06.2015 - 02.2017
FEP Account Advisor I
Blue Cross Blue Shield of Louisiana
02.2014 - 04.2015
Associate of Art - Humanities
Southern University at Shreveport
Bachelor of Science - Health Care Administration
Charter Oak State College
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