Naty Contreras

Healthcare operations professional with 15+ years of experience in managed care, provider relations, claims resolution, and utilization management. Strong background in regulatory workflows, provider support, Medicare and Medicaid programs, and cross-functional operations. Bilingual in English and Spanish.

Manager, Network Relations at AETNA, INC. (2023-04 – Present)

• Served as primary liaison for providers on reimbursement, credentialing, and provider data issues.
• Resolved complex claims, billing, authorization, taxonomy, and NPI-related concerns.
• Conducted provider education, compliance reviews, and site visits to improve engagement.
• Partnered with internal teams on HEDIS, CAHPS, and value-based initiatives.

CDR II Operations Account at AETNA, INC. (2022-12 – 2023-04)

• Supported Medicaid health plans through claims rework and remediation projects.
• Assisted recovery efforts and completed priority claims work within deadlines.
• Helped resolve issues affecting claims accuracy and operational performance.

Senior Health Concierge at AETNA, INC. (2020-03 – 2022-12)

• Assisted members with Medicaid renewals, LIS applications, and care coordination.
• Investigated claims issues and explained Medicare and Medicaid benefits.
• Completed outreach and assessments within required timelines.

Care Management Associate at AETNA, INC. (2018-07 – 2020-03)

• Processed utilization management requests for inpatient and outpatient services.
• Created authorizations and supported medical record intake workflows.
• Assisted with denial issues, appeals, and benefit questions.

Program Coordinator at CENTENE CORPORATION (2015-07 – 2017-09)

• Coordinated utilization management intake for Medicare plan members.
• Reviewed authorization requests, coding details, and clinical documents.
• Audited authorizations and claims to address denial-related issues.

Senior Customer Service Representative & Referral Coordinator at CENTROMED (2009-02 – 2015-02)

• Managed referrals and authorizations for specialty, radiology, and surgical services.
• Coordinated scheduling, insurance verification, and benefit reviews.
• Obtained records and approvals to support continuity of care.

Bachelors in Business Administration – Strayer University

Associate Degree in Medical Insurance & Billing – Career Point