Ciara Cole Email & Phone Number

Tampa, Florida

• Analyze user requirements and coordinate communications about the requirements for the design, implementation, testing, integration, and verification for application software projects• Manage and oversee project pre and post implementations through project life cycle by working with cross functional teams to reach milestones and adhere to established project timelines• Continuously search for sales growth opportunities to increase revenue and secure contract extensions

Tampa/St. Petersburg, Florida Area

• Develop and implement a network development plan based on analysis using corporate marketing and contracting techniques in assigned service area. • Manage negotiations, delegation agreements, credentialing requirements, risk management and relationships with all strategic partners. • Developed Network Adequacy Reports to identify provider network needs, network gaps and opportunities for network expansions.• Contracted with providers, hospitals, Medical Clinics and other service… Show more • Develop and implement a network development plan based on analysis using corporate marketing and contracting techniques in assigned service area. • Manage negotiations, delegation agreements, credentialing requirements, risk management and relationships with all strategic partners. • Developed Network Adequacy Reports to identify provider network needs, network gaps and opportunities for network expansions.• Contracted with providers, hospitals, Medical Clinics and other service contractors to build network of providers to meet VA contract of network adequacy for Medical Disability Evaluations. Show less

Tampa/St. Petersburg, Florida Area

• Extensive knowledge of various insurance company contracts and fee schedules to price LTC, Medicare, Medicaid, Worker’s Comp, Commercial, SNF, pharmacy claims• Responsible for gathering and validating requirements, coordinating project tasks, regular communication to client, identifying appropriate resources needed, and developing schedules to ensure timely completion of projects

Tampa/St. Petersburg, Florida Area

• Apart of project management team where we come up with various initiatives for claims and customer services departments to teach the healthcare system and to share best practices• Function as an information source through telephonic assistance to members, providers, billing agencies, provider relations and various company/department staff

Tampa/St. Petersburg, Florida Area

• Handled disputes with member’s medical plans, provider relations escalation calls and assured proper processing• Handled Medicare, Medicaid, STD Claims and appeals and DME claims and billing• Experience in auditing and reading provider contracts and performing random audits to ensure proper processing

Tampa/St. Petersburg, Florida Area

• Manuscript editor of Graduate Thesis and Dissertations• Ensure proper paperwork and formatting of Thesis and Dissertation are done before graduation• Supervised a planning team for Graduate School Events• Recorded student information for Graduate Admission in Microsoft applications including data entry