Bethany Carter Email & Phone Number

Greensboro, NC, US

Greensboro, North Carolina

• Direct oversight of Medicare Advantage Provider & Network Services, Part C Claims, and Appeals, and Grievances departments
• Supports contracting strategies and reimbursement initiatives by working directly with contracting to support Plan’s financial performance.
• Created and staffed Plan’s Provider Services department to deliver all provider call center support (including claims), onboarding, education and trainings, network materials and Quality and RAF support.
• Responsible for providing oversight and leadership regarding direction, policy and procedure, and compliance with CMS requirements related to all areas of transactional processing including claims, provider services.
• Manage TPA Operations including configuration (provider contracts, network loads and benefits) and claims.
• Provides strategic leadership to Plan staff

Greensboro/Winston-Salem, North Carolina Area

Greensboro, North Carolina

Greensboro/Winston-Salem, North Carolina Area

• Responsible for the establishment and ongoing management of relationships with Triad HealthCare Network (“THN”) providers and their office staff as well as vendors and payers regarding the implementation and usage of.
• Responsible for providing support and assistance to THN and THN providers to achieve targets outlined in established incentive programs in addition to the achievement of recognition and/or designation from national.
• Coordinated the implementation, training, support, and ongoing maintenance of all such THN resources as well as the tracking and reporting of the usage of these resources.
• Served THN providers and their staff with contracted payer claims resolution and provided management and support of divisional meetings to report and review quality and cost utilization performance.

Greensboro, NC

Key responsibility is to provide leadership and management of the practices 24 employees with 5 physicians, 3 advanced practice providers, and a patient base of over 10,000. Human resource roles include: staff management and meetings, provider call schedules, training, disciplinary and grievance, performance reviews, contract negotiations, payroll and.

Efficiently handle all accounts payable and receivable transactions for two golf shops averaging gross annual sales of $350,000. Oversee golf daily charge activities for the area’s most prestigious club with a membership base of 1,400. Track all golf activities for two award-winning courses with average annual rounds of 250,000 and round revenue of over $3.

Responsible for all P&L management, business plan, annual operating budget, and human resources. Primary daily and weekly activities consisted of all accounts receivable, accounts payable, and payroll for a business maintaining an average annual sales of $600,000 and a lifetime sales of over $3,500,000. Supported building a strong, recognizable regional.

Managed all accounts payable and receivables, and related staff for this unique 10+ provider, three-site pediatric practice. Served as liaison between GCH and it’s partners: Guilford County Health Department, Moses Cone Health System, High Point Regional Health System and the Pediatric Teaching Program at MCHS. Worked closely with Executive Director to.

Successfully maintained the highest call volume and service satisfaction in provider assistance for each month of employment. Services included provider education on claim submission procedures, policy benefits, and assistance in claim review and dispute procedures. Earned the unique opportunity to cross assist the department with state-wide, on-site.

Mha, Masters In Health Care Administration

Mba, Master Of Business Administration

Ba, Psychology, Cum Laude

Activities and Societies: President and Member, Beta Beta Beta (Biology Honor Society), Member, Omicron Delta Kappa (Leadership Honor.