In my previous role, I worked extensively with managed care systems, ensuring compliance with state and federal regulations. I regularly reviewed contracts, claims, and provider networks to ensure adherence to guidelines. I also conducted audits and provided training to staff on compliance updates. My attention to detail and proactive approach helped minimize risks and maintain operational efficiency.

When resolving disputes, I focus on clear communication and collaboration. I review the issue thoroughly, gather all relevant documentation, and facilitate discussions between parties to reach a fair resolution. By maintaining a neutral stance and prioritizing mutual understanding, I ensure that disputes are resolved efficiently while preserving positive relationships between providers and payers.

I prioritize open communication and regular check-ins to build trust with providers. I actively listen to their concerns, provide timely updates on policy changes, and offer solutions to streamline processes. By demonstrating reliability and understanding their needs, I foster strong partnerships that enhance collaboration and improve service delivery within the managed care framework.

I stay informed by subscribing to industry newsletters, attending webinars, and participating in professional development courses. I also network with peers and join relevant forums to exchange insights. This proactive approach ensures I remain current on policy changes, enabling me to implement updates effectively and maintain compliance within the organization.

In my previous role, I identified inefficiencies in the claims processing system and implemented a digital tracking tool to streamline workflows. This reduced processing times by 20% and improved accuracy. I also trained staff on the new system, ensuring smooth adoption. These changes enhanced productivity and reduced operational costs while maintaining high service standards.