Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Susana Medina

Manteca

Summary

Health Plan of San Joaquin, I leveraged my Provider Relations expertise and exceptional communication skills to enhance provider satisfaction and streamline operations. My proactive approach in resolving inquiries and disputes significantly improved provider relations and operational efficiency, showcasing my ability to multitask and solve problems effectively.

Qualified Representative with robust background in provider services. Proven track record of resolving provider inquiries and facilitating smooth communication between providers and healthcare. Demonstrated ability to utilize problem-solving and communication skills to enhance provider satisfaction and operational efficiency.

Professional and prepared for role in provider services. Skilled in managing provider relationships, resolving inquiries efficiently, and ensuring compliance with regulatory standards. Strong focus on team collaboration and achieving results. Known for adaptability and reliability. Proficient in communication, conflict resolution, and data management. Personable and dedicated to fostering positive working relationships.

Collaborative leader partners with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings. Uses independent decision-making skills and sound judgment to positively impact company success.

Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.

Overview

18
18
years of professional experience

Work History

Provider Service Representative

Health Plan Of San Joaquin
03.2007 - Current
  • Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
  • Streamlined operations by managing a high volume of incoming calls/emails for medical providers seeking information or assistance.
  • Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
  • Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
  • Increased efficiency by accurately entering provider data into company systems and databases.
  • Improved communication between providers and HPSJ, leading to better understanding of DHCS updates and mandatory trainings.
  • Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
  • Established rapport with provider community by attending industry conferences and other networking events.
  • Served as a reliable resource for both internal staff and external partners, offering guidance on best practices in managing provider relationships.
  • Analyzed performance metrics for assigned territory, identifying opportunities for growth and improvement within the network.
  • Enhanced communication between providers and company with regular, informative updates.
  • Trained new personnel regarding company operations, policies and services.

Education

High School Diploma -

Merrill West High
Tracy
05-1997

Skills

  • HIPAA compliance
  • Claims processing
  • Goal-oriented mindset
  • Call center experience
  • Provider relations
  • Teamwork and collaboration
  • Customer service
  • Time management
  • Problem-solving skills
  • Multitasking Abilities
  • Reliability
  • Excellent communication
  • Relationship building

Languages

Spanish
Native or Bilingual

Timeline

Provider Service Representative

Health Plan Of San Joaquin
03.2007 - Current

High School Diploma -

Merrill West High
Susana Medina