Theresa Ellis
Omaha
Summary
Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Provider Relations Manager
Molina Healthcare of Iowa
01.2023 - Current
- Primary Point of Contact between Molina Health Plan and providers
- Work directly with providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service.
- Resolved complex provider issues that may cross departmental lines.
- Conducts regular provider site visits.
- Provides on-the-spot training and education as needed.
- Independently troubleshoots problems as they arise.
- Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders.
- Independently delivers training and presentations to providers and their staff, answering questions that come up on behalf of the Health plan.
- Trained other Provider Relations Representatives as appropriate.
Provider Experience Manager
Healthy Blue
11.2021 - 12.2022
- Act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.
- Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on site and routing to the appropriate party for resolution.
- Receive and respond to external provider related issues.
- Investigate, resolve and communicate provider claim issues and changes.
- Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem-solving.
- Perform provider orientations, including writing and updating orientation materials.
Provider Relations Specialist
Iowa Total Care
12.2019 - 10.2021
- Act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.
- Conduct monthly face-to-face meetings with the providers.
- Receive and respond to external provider related issues.
Credentialing Specialist
Senior Vision Services
07.2019 - 01.2020
- Credential and re credential providers with Medicare, Medicaid and Commercial payors in various states.
- Maintain CAQH and One Health Port.
- Handle license renewal and apply for state licenses for providers.
- Communicate with Providers to ensure credentialing and re credentialing is completed in the required time frame.
Education
Certificate - Health Information (HIM Billing and Coding Specialist)
College of St. Mary's
Omaha, NE12.2006
Diploma - undefined
Millard North High School
Omaha, NE05.1989
Skills
- Knowledge of healthcare systems
- Provider relationship management
- Educational presentations
- Provider orientations
- Teamwork and collaboration
- Problem-solving
- Attention to detail
- Multitasking Abilities
- Excellent communication
- Computer skills
- Organizational skills
- Team leadership
- Effective communication
- Problem resolution
- Verbal and written communication
- Relationship building
Certification
Health Information Management Billing and Coding Specialist
Timeline
Provider Relations Manager
Molina Healthcare of Iowa
01.2023 - Current
Provider Experience Manager
Healthy Blue
11.2021 - 12.2022
Provider Relations Specialist
Iowa Total Care
12.2019 - 10.2021
Credentialing Specialist
Senior Vision Services
07.2019 - 01.2020
Diploma - undefined
Millard North High School
Certificate - Health Information (HIM Billing and Coding Specialist)
College of St. Mary's
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