Provider Relations Consultant / Escalations Specialist at Gainwell Technologies (2021-11 – 2025-06)
- Managed the end-to-end provider enrollment and onboarding workflows with provider offices, successfully reducing processing cycle time by 85%.
- Spearheaded the complex credentialing process for 250+ healthcare providers, ensuring absolute compliance with NCQA, CMS, state, federal, and organizational standards.
- Maintained accurate, highly secure, and up-to-date provider records in centralized database tracking systems and credentialing software.
- Served as primary remote liaison between corporate leadership and the state Medicaid community to resolve complex billing and technical goals.
- Processed, reviewed, and submitted high volumes of provider applications daily while maintaining an environment where accuracy is key.
- Assisted providers with complex claim denials, billing resolution, and technical troubleshooting while meeting strict SLA requirements.
Professional Business Analyst at Gainwell Technologies (2019-01 – 2021-12)
- Gathered and documented client requirements, creating conceptual data and process models for system enhancements.
- Drafted and presented formal Statements of Understanding (SOU) to key stakeholders.
- Conducted monthly regression testing and meticulously tracked SIT, UAT, and PROD deployments.
- Utilized SSI/Medicaid portals and Meditech software to bill complex hospital claims; accurately applied CPT/ICD-10 coding standards.
Business Analyst I at Centene Corporation (2017-01 – 2019-12)
- Identified and analyzed user requirements, procedures, and system bottlenecks to implement data-driven process improvements.
- Developed curriculum and trained new corporate employees on internal systems, industry-specific business terms, and operational functions.
- Resolved escalated member coverage issues, verified insurance benefits, and collaborated with senior management on operational strategies.
Provider Field Representative at Hewlett Packard Enterprise (2016-01 – 2017-12)
- Developed strategic provider relationships and conducted virtual and on-site visits for professional training and education.
- Researched escalated customer and technical issues, coordinating comprehensive outreach webinars to resolve systemic concerns.
Patient Account Analyst at Cardiology and Medicine Clinic (2014-01 – 2015-12)
- Researched complex denied claims, resubmitted corrections for payment, and managed high-volume billing across multiple insurance carriers.
- Handled patient front-office data management, scheduled diagnostic medical testing, and conducted extensive insurance eligibility verifications.
Public Housing Manager / FSS Coordinator at Housing Authority (2007-01 – 2012-12)
- Managed 273 residential housing units, directing full-scale case management, quality inspections, and tenant counseling workflows.
- Supervised operational staff, maintained strict regulatory records, and coordinated services for over 50 families.
