Summary
Overview
Work History
Education
Skills
Awards
Timeline
Generic

TONYA M. SAGE

Gridley

Summary

Strategic and detail-oriented healthcare operations professional with over 20 years of experience in provider relations, data management, claims processing, and issue resolution. Expertise in advocating for provider needs while analyzing complex data sets to inform decision-making and drive initiatives that enhance both provider and member experiences. Demonstrated success in managing cross-functional teams, educating stakeholders, and implementing compliance measures that lead to significant performance improvements across healthcare systems. Committed to fostering collaboration and innovation to achieve operational excellence in the ever-evolving healthcare landscape.

Overview

18
18
years of professional experience

Work History

Custom Network Liaison

UnitedHealthcare
01.2022 - Current
  • Managed strategies to achieve regulatory compliance.
  • Clarified contract intent by amending over 300 Special Processing Instructions, resolving $3.9M overpayment issue.
  • Strategic liaison for Customer Specific Providers (CSP), resolving escalated issues and advocating for operational improvements.
  • Extract, analyze, and present data insights to support strategic planning and decision-making across business units.
  • Executed strategies with stakeholders to optimize system performance and provider data processes.
  • Facilitate audit readiness and compliance by maintaining comprehensive documentation and supporting regulatory reporting efforts.
  • Served as the primary point of contact, fostering strong relationships between internal teams and external partners.
  • Coordinated multiple projects simultaneously, ensuring timely completion and alignment with organizational objectives.
  • Aided in the development of training materials, contributing to the ongoing education of team members and improved performance outcomes.

Provider Install Specialist

UnitedHealthcare
01.2016 - 01.2022
  • Executed timely and accurate fee schedule installations in alignment with provider contracts, ensuring compliance with reimbursement policies.
  • Managed contract amendments including rate adjustments, terminations, and updates with precision and attention to detail.
  • Leveraged multiple systems (Pulse, Nice, NDB, Core, Cosmos) and Microsoft Office tools (Excel, Word) to support data integrity and operational efficiency.
  • Authored and maintained comprehensive Standard Operating Procedures (SOPs) streamline workflows and ensure consistency across teams.
  • Took full ownership of follow-up actions, collaborating cross-functionally to resolve issues and maintain service excellence.
  • Conducted in-depth data analysis to identify discrepancies, troubleshoot provider installation challenges, and implement corrective measures.
  • Implemented new training programs for staff, leading to higher employee retention rates and better overall performance.

Advocate4Me Representative Sr.

UnitedHealthcare
01.2008 - 01.2016
  • Managed high call volumes while effectively resolving complex member inquiries.
  • Served as a Senior lead representative, mentoring peers and supporting escalated cases to ensure timely and accurate resolution.
  • Processed a wide range of medical claims with precision, maintaining compliance with HIPAA regulations and reimbursement policies.
  • De-escalated sensitive situations with professionalism and empathy, guiding members through issue resolution from start to completion.
  • Maintained accurate documentation and supported coding updates and benefit verification processes.
  • Consistently exceeded performance metrics and service standards through effective communication and problem-solving.
  • Streamlined office procedures for handling constituent inquiries, significantly reducing response time.
  • Mentored junior team members, enhancing their knowledge and skills in conflict resolution techniques.
  • Provided exceptional support during high-pressure situations, diffusing tension and facilitating productive discussions towards resolutions.

Education

HIGH SCHOOL DIPLOMA -

Venture Academy
Stockton, CA
06.2003

Skills

  • Relationships
  • Data Analysis
  • Claims Systems
  • Microsoft Office
  • Excellent communication
  • Quick thinker

Awards

Honored as a UHC Service Hero in 2024 for outstanding contributions to provider operations and service excellence., Make it Matter Hall of Fame inductee June of 2024

Timeline

Custom Network Liaison

UnitedHealthcare
01.2022 - Current

Provider Install Specialist

UnitedHealthcare
01.2016 - 01.2022

Advocate4Me Representative Sr.

UnitedHealthcare
01.2008 - 01.2016

HIGH SCHOOL DIPLOMA -

Venture Academy

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TONYA M. SAGE