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<pre>Array ( [var] => cut_url ) </pre> Resume for Millicent JD P. for Project Manager / Insurance in Dallas, Texas. Search More Resumes for Project Manager on #EV3WIPLJV

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Resume for Millicent JD P. for Project Manager / Insurance in Dallas, Texas

Occupation: Project Manager Industry: Insurance
Country: United States City: Dallas
State: Texas ZIP: 75204

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Millicent Juliet Duncan P.
Brownstone Ct, MB
Dallas, TX, USA,
Career Objective: Experienced managed care healthcare professional seeking a permanent full time position that will utilize my
vast healthcare knowledge, strong people skills, organizational abilities and business experiences in a challenging environment that
offers varied and potential growth to qualified individuals.
Ewing’s Associates/United Healthcare, Plano, TX
NETWORK DEVELOPMENT SPECIALIST Texas and Nebraska Community and State Group: Develops the provider network
physicians, hospitals, pharmacies, ancillary groups and facilities, etc. yielding a geographically competitive, broad access, stable
network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable
product for customers and business partners. Evaluate and negotiate contracts in compliance with company contract templates,
reimbursement structure standards, and other key process controls. Responsibilities also include establishing and maintaining strong
business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an
appropriate distribution of provider specialties. Use pertinent data and facts to identify and solve a range of problems within the
contractual scope and other areas of expertise. Investigate and resolve nonstandard requests and problems as assigned or with
assistance from others. Work within a specific knowledge area. Prioritize and organize own work to meet deadlines. Provide
explanations and information to others on topics within area of expertise. Use Medicaid experienceÊand knowledge of Texas
Medicaid programs. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or
technical information in a manner that others can understand, as well as ability to understand and interpret complex information form
others; strong interpersonal skills, establishing rapport; working well with others and strong customer service skills. Remote and
Bravo Health Health Spring, Frisco, TX
MANAGED CARE PROVIDER OPERATIONS SITE REVIEW SPECIALIST: Bravo liaison between the provider communities, Health
and Human Services Commission HSC staff. Performed a variety of functions related to compliance. Ensured compliance codes
were met with contractual requirements and state regulations. Review patient medical records to ensure appropriate record keeping.
Inspect the provider office for safety and contractual compliances. Assesses provider compliance with contract requirements; ensure
provider is in compliance with federal and state laws. Communicate findings to treating physician. Provide professional and analytical
support focusing on the analysis, program development and evaluation of applicable medical services offerings. Analyze and
communicate providers’ performance measures; makes recommendations on methods for improvement if applicable. Advises and
collaborates with client partners with regard to the practitioner credentialing as well as ensure the practitioner has completed the
necessary provider enrollment applications. Telecommuter; travel as necessary to meet targeted needs.
Bravo liaison between contractual practitioner’s, medical staff offices and related entities concerning credentialing and provider
enrollment. Work closely with the administrator or manager each managed care entity to assist in answering questions and collecting
outstanding and crucial credentialing items for approval. Maintain current credentials for all active providers. Comply with all
HIPAA/JCAHO, MEDICARE, and MEDICAID rules and regulations. Implement, coordinate, compile, and prepare reports pertaining to
existing Practitioners as requested by management. Preparation of all correspondence associated with the credentialing process;
additional duties as assigned. Remote and telecommute.
FAST TRACK FEE NEGOTIATOR: Review UB and HFCA claims, negotiate proposed settlement; review and negotiate
contractual proposals regarding hospital and physician settlements. Fast Track negotiating.
PERSONAL CARE ATTENDANT: Assist the functioning limited client in performing daily living activities; provide quality in home care
in accordance with the service plans developed through the home health agency, the client, case managers, CBADADS, MEDICAID,
MEDICARE, and the clients’ physician. Assist the disabled patient with completing the online Social Security Disability application and
other requested task.
MANAGED CARE CONTRACT ANALYST CONTRACTUAL: Analyze and implement hospital billing and managed care contracts
determining system requirements. Using IMACS contract management system to load and translate contracts into algebraic,
arithmetic and Boolean arguments. Utilize SQL queries, advanced excel formulas, functions and project scheduling tools. Collaborate
with client services, account managers, contract implementation, audit and external clients to resolve issues in implementation and
maintenance facilities. Create models, run test of completed product, identify and resolve variances against production data. Utilizing
financial models and analysis in negotiating rates with providers; evaluate and negotiate contracts in compliance with company
contract templates, reimbursement structure standards, and other key processes. Establish and maintain strong business
relationships with our providers and clients. Telecommuter; travel as necessary to meet targeted needs.
LEAD CONTRACT SPECIALIST: Served as liaison to hospitals, physicians, ancillaries and other healthcare organizations regarding
contractual issues. Initiate, implement, negotiate, generate and track Letters of Intent, Letters of Agreement, contracts and
amendments from initial draft to full execution. Support network development local and nationwide to including researching, recruiting
and negotiating with providers. Participate in the evaluation of provider network and implementation of strategic plans to meet
Galaxy’s network adequacy standards. Clearly and professionally communicate contract terms, payment structures, and
reimbursement rates to physician, hospital and ancillary providers. Assist in analysis and coordination of amendments,
reimbursement, and language changes. Request information of billing codes, services provided and other information needed to
complete the contract profile. Coordinate preparation and routing distribution of documents to complete the contracting process in a
timely and thorough manner. Evaluate and negotiate contracts in compliance with company contract templates, reimbursement
structure standards, and other key processes. Establish and maintain strong business relationships with our providers and clients.
Telecommuter; travel as necessary to meet targeted needs.
PROVIDER/CLIENT RELATIONS REPRESENTATIVE: Using traditional phone and online communications, served as liaison for the
Texas Provider Community and Department of Health and Human Services. Provide ongoing updated information to the provider and
member community regarding Texas State Medicaid Programs. Implement and conduct provider and client education on TMHP
policies and procedures, programs, products, operational workflows, participation requirements and selfservice capabilities. Assist
provider with escalated service issue resolution and fee dispute resolution. Assist provider with escalated service issue resolution and
fee dispute resolution. Track/trend provider issue outcomes in order to develop overall solutions and proactive problem resolution.
Meet or exceed performance goals. Educate and promote enrollment in available electronic and online services enduring that network
compliance is monitored through regular reviews of electronic and online service utilization reports. Followup to resolutions; escalate
and/or involve other resources as needed to ensure the highest level of provider and member satisfaction.
PRINTER SERVICES DIVISION DISPATCHER: Receive incoming telephone calls. Assess and dispatch service calls. Provide
feedback to the call center for call loading improvements and customer concerns. Provide field team with parts support to help
minimize return trips. Assist the field team with call overloads and direction. Prioritize and determine best available technician to
complete job. Maintain the quality, quantity, and timeliness of dispatch to customer needs, questions or problems. Ensure proper
communication with customer to gather all pertinent information for service call. Consistent followup to ensure completion and
satisfaction. Track all service calls and provide service call reporting and metrics to management. Maintain service call logs and
service manuals. Perform monthly technician’s rides to better understand team support requirements and business needs. Promote
the sale and implementation of service agreements to customers. Coordinate with National Accounts service dispatch. Provide
administrative/backup assistance to Service Supervisor. Perform duties and responsibilities as described in the quality system.
Perform work according to the Field Operations Policy and Procedures Manual. Perform other assignments as directed by manager in
support of service operations. Work with Installation Coordinator on manpower sharing opportunities to increase productivity. Maintain
quality observation measurements projected by management.
US & CANADIAN GENERAL SERVICES REPRESENTATIVE: Using online communication, perform service activities such as
systems assurance, installation planning, account management, systemslevel problem determination, discontinuance and relocation
of IBM and nonIBM systems and products. Perform various degrees of problem determination and resolution of desktop hardware
and software problems through the effective use of available technical resources, per contracted service level agreements.
Accountable for ensuring a high level of customer satisfaction with service delivery, technical sup

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