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J. R.

Master of Science

IN

Public Health

AT

Southern New Hampshire University

2017

3.8 GPA

LOOKING FOR

Entry-level Jobs

In

Public Health

Near

Ontario

ABOUT ME

Truly a go getter! Constant achiever - always looking for ways to improve. Whether through a class, workshop or a seminar. Realizing that one should always seek to re-brand and stay in a perpetual atmosphere of learning. Creativity is key and staying current on societal issues. Change is not easy but it is ALWAYS beneficial!!!

WORK & INTERNSHIP HISTORY

Lead Provider Relations Analyst
UCLA Health | May 2012 - Present

•Maintain patient/member confidentiality to satisfy HIPAA guidelines and regulations with regards to patient health information (PHI).
•Maintain monthly provider reports which are disseminated to the Health Plans indicating any changes or updates in provider status with UCLA Medical Group.
•Responsible for educating office staff and providers on Division of Financial Responsibility (DOFR) between UCLAMG and the contracted Health Plans.
•Conduct provider orientations; communicate policies and procedures and regulatory compliance matters as it directly impacts the clinicians and office personnel.
•Educate provider/members on currently active contracts with the Health Plan and the specific Lines of Business (HMO, PPO, POS & EPO).
•Intermediary between UCLAMG, the Health Plans and the contracted provider network to actively research and resolve provider complaints and contractual concerns/issues.
•Resolve administrative problems affecting network providers, patients and plans within contracted guidelines for which the network is responsible.

COURSEWORK

OTHER