Contract Negotiator / Strategic Network Account Manager - One Call CM - Jacksonville, FL
(2022-01 - 2026-03)
- Negotiate and renegotiate provider contracts to ensure network adequacy and competitive pricing.
- Review agreements for compliance with state regulations and organizational guidelines.
- Audit provider credentialing documentation for accuracy and completeness.
- Maintain and process provider records using Salesforce and internal systems.
- Build and maintain positive provider relationships while resolving concerns and minimizing provider abrasion.
- Assist with auditing initiatives, special projects, and process improvement efforts.
Associate Specialist, Provider Contracting - Molina Healthcare - Jackson, MS
(2020-02 - 2022-01)
- Reviewed practitioner and facility credentialing applications to ensure compliance with company standards.
- Conducted database research and verification of provider credentials and documentation.
- Processed provider files and maintained accurate records within CRM systems.
- Collaborated with providers to resolve credentialing and claims-related issues efficiently.
- Supported provider contracting operations through detailed documentation review and communication.
Claims Liaison II - Magnolia Health - Jackson, MS
(2012-02 - 2020-01)
- Investigated healthcare provider complaints and determined appropriate corrective actions.
- Analyzed claim denials and identified trends related to reimbursement and processing errors.
- Prepared claim impact reports and educated providers on billing and claims procedures.
- Audited provider contracts and claim payments to ensure reimbursement accuracy.
- Responded to Division of Medical inquiries and escalated issues as necessary.
- Identified configuration and system-related issues affecting claims processing.
- Developed workflow improvements to increase departmental efficiency.
- Utilized systems including CRM, Cenpatico, Portico, Omni, Amisys Advance, FileNet, and Cenprov.
Credentialing / Audit Specialist - Magnolia Health - Jackson, MS
(2012-02 - 2020-01)
- Negotiated and prepared standard provider contracts in accordance with state guidelines.
- Conducted credentialing audits for provider and practitioner applications.
- Verified provider data and ensured compliance with Centene standards and policies.
- Assisted with provider outreach, audit initiatives, and contract implementation projects.
- Resolved provider concerns related to credentialing and claims processing.
Administrative Assistant - Magnolia Health - Jackson, MS
(2012-02 - 2020-01)
- Coordinated contract processing from initiation through completion.
- Reviewed contracts for accuracy and monitored RightFax documentation systems.
- Managed provider correspondence and processed contract requests.
- Maintained databases and reports using Microsoft Excel.
- Scheduled meetings and prepared detailed meeting minutes.
Paralegal - Mississippi Center for Legal Services - Jackson, MS
(2006-03 - 2012-02)
- Drafted pleadings, legal correspondence, and court-related documentation.
- Communicated directly with clients regarding case information and service eligibility.
- Managed calls and operated a multi-line switchboard system.
- Scheduled court dates and prepared and filed legal documents with the court system.
- Participated in legal fairs, senior citizen outreach events, and estate planning workshops.
Legal Secretary - City Attorney's Office - Jackson, MS
(2005-08 - 2006-03)
- Prepared pleadings and maintained organized filing systems and legal indexes.
- Monitored legal deadlines and coordinated court hearing schedules.
- Communicated with court personnel and administrative legal staff regarding case matters.
Deposition Paralegal - Watkins & Eager PLLC - Jackson, MS
(2005-01 - 2005-08)
- Coordinated depositions with attorneys, physicians, nurses, and opposing counsel across multiple states.
- Scheduled court reporters and managed deposition logistics.
- Summarized deposition transcripts and prepared dismissal orders.
Legal Assistant - McDavid, Noblin and West, PLLC - Jackson, MS
(2002-10 - 2005-01)
- Prepared wills, testaments, and publication notices.
- Transcribed legal dictation and maintained client records and databases.
- Filed legal documents with state and court offices.
