Professional Relations Resume

Desired Industry: Insurance	SpiderID: 7130
Desired Job Location: Baltimore, Maryland	Date Posted: 5/25/2006
Type of Position: Full-Time Permanent	Availability Date: 06/15/06
Desired Wage: 40000
	U.S. Work Authorization: Yes
Job Level: Experienced with over 2 years experience	Willing to Travel: Yes, More Than 75%
Highest Degree Attained: High School/Equivalent	Willing to Relocate: Yes

Objective:
To obtain a professional position as a Provider Relations Representative that will leverage my Professional Relation skills.

Experience:
02/08/2005- Present Professional Relations Representative
United Health Group/Dental BenefitsProviders – Rockville, MD
Assist network providers request via in-bound calls, e-mail and internal dept referrals, regarding eligibility/claims/contractual agreements. Work as a liaison between the claims dept and network providers regarding claim issues. Negotiate contractual agreement for qualifying special deal of fee schedule. Make proactive calls and visits to build relationships with network providers. Assist providers with education relating to DBP’s group plans.

06/01/2004 – 02/08/2005 Provider Relations Representative
Health Net Federal Services, Inc. - Arlington, VA
Interact with health care providers and their office staff via phone and
Email. Provide information to TRICARE providers with regards to the
healthcare program and Provider Network Operations. Serve as the key provider of education on healthcare policy and procedures, contractual guidelines and resolving complex issues when needed. Provide technical replies to TRICARE operations, payment coding, claim submission requirements and fee/payment explanations.

02/11/2002 – 05/31/2005 Quality Analyst
Sierra Military Health Services – Baltimore, MD
Created the best possible quality monitor program by using the Microsoft Access system to evaluate and score employees in the call center. Assist with the hiring and training of new employees to advise of call centers expectations. Advise of Do’s and Don’ts by providing positive feedback to employees relating to call centers policy and procedures.

07/01/1998 – 02/11/2002 Technical Specialist
Trailblazers Health Services, Inc. – Timonium, MD
Assist call center customer representatives with the technical procedures of claims issues such as Medicare Secondary Payer, Skilled Nursing Facility and Medical claim reviews.

09/11/1993 - 07/01/1998 Customer Service Sales Representaitve
Lippincott, Williams & Wilkins Medical Publishing – Baltimore, MD
Received inbound/outbound calls regarding the purchase of medical books, journals and continue education material.

Education:
Morgan State University Baltimore, Maryland

Skills:
Microsoft Office Access
Microsoft Office Excel
Microsoft Office Word
Microsoft Office Powerpoint
Multiclaims
PGMMS
Facets data base system

Reference:
Upon request

Candidate Contact Information:

Name: Teresa Berry
Street:	Phone: 41046646676
City: Baltimore	Fax: -
State: Maryland
Zip: 21215
Web Site: