gloribi nickens

provider account executive

About

Highly motivated healthcare professional with over 20 years of experience who works well with minimal supervision. Strong verbal, written and analytical skills. Comfortable interacting with all levels of the organization. A team player with a strong focus on customer service who is attentive to detail and produces quality results. Edit

Country

united states

City

philadelphia

Industry

hospital & health care

Skill

managed care, medicaid, medicare, healthcare, hipaa, healthcare management, hospitals, health insurance, physicians, provider relations, healthcare consulting, network development, credentialing, utilization management, physician relations, ncqa, hedis, healthcare information technology, health policy

Experience

provider account executive

amerihealth caritas

2020-3 - Present · 6 yrs 7 mos

network account manager

health partners plans

2010-1 - 2013-12 · 4 yrs

Manage several individual and group physicians contracts as well as DME and Home Infusion companies engaging in regular problem solving activities which include policy, claims, billing, data changes, fee schedules and compliance issues. Analyze claim data, network data, policy update, hospital operations data and work to turn the information into effective action.

project manager

bright medical technology

2017-9 - Present · 9 yrs 1 mo

manage care coordinator

horizon blue cross blue shield of new jersey

2002-7 - 2006-11 · 4 yrs 5 mos

Work hand in hand with Nurses, Medical Directors and Physical Therapist managing utilization for members when it applied to services such as hospital stays, surgery, lab work, etc. Performed selected medically appropriate protocols: including telephone interviews and collection of information from doctors/therapist and patients regarding Medicare, HMO, POS, Direct Access, New Jersey Plus and PPO products. Executed selected concurrent review activities including procedure review and communication with facilities/providers to obtain patient information and medical records. Provided tactful and courteous solutions and education to providers regarding member eligibility, Manage Care policies and procedures, and provider participating.

emergency room coordinator

healthpartners

2008-7 - 2010-1 · 1 yr 7 mos

Engage members via telephonic outreach to educate on appropriate use of ER and encourage utilization of PCP. Participate in the development and implementation of all departmental policies, procedures and goals, and assured numeric targets for phone lines were met.

provider relations team leader

independence blue cross

1998-7 - 2002-6 · 4 yrs

Served as a technical resource to a unit of 20 Provider Services Rep. Performed quality assurance reviews on phone calls taken by service reps on a monthly basis followed by a report to manager. Prepare monthly reports to manager identifying training needs, call type trends and project updates. Responsible for interviews of new prospects as well as training of new employees.

independent business owner

premier designs

2002-3 - 2015-1 · 12 yrs 11 mos

I have been an Independent Jewelry Consultant for quite some time and I love making women feel and look amazing with my awesome jewelry. Rewarded for sales and marketing strategies. Built a team of 7 and led them to success in their own business. Take a look at my website: jewelryladygloribi.mypremierdesigns.com