Gladys Torres Email & Phone Number

Remote

• As a Provider Contract Installation Specialist I am responsible for the development, setup, maintenance, and optimization of provider contracts and network configurations to ensure accurate pricing, claims routing, and.
• Manage Provider OPI (specific network assignments) and Employee OPI (network prioritization).
• Facilitate claims routing and accommodate customer intent through effective OPI setup.
• Implement recycle holds for network, provider file, or reimbursement issues to prevent claim errors.
• Review and resolve contract-related CSI tickets (e.g., provider underpayment, pricing discrepancies).
• Use tools such as DBeaver to query pricing data and ensure reimbursement accuracy.

California, United States

• As a Provider Installation Specialist, I use to manage contract installation and administration, including structure and billing setup, eligibility collection, and database loading. I prepare plan materials, ensure.
• Conducted thorough audits to ensure accuracy, providing targeted feedback and guidance.
• Investigated and addressed non-standard requests with analytical problem-solving.
• Ensured audit documentation met quality standards, aligned key risks and controls to audit test objectives, and completed work paper documentation.
• Evaluated internal workload, provided feedback, and suggested improvements

• Handled customer service issues such as eligibility, benefits, claim issues, reimbursement, prior authorizations, appeals, and disputes. Played a key role in supporting the manager to facilitate team skill enhancement.
• Processed reimbursement requests, tracked expenses accurately, and collaborated for proper documentation and approval.
• Provided support to the manager in meetings, including those related to Star HEDIS.
• Ranked as the top performer in closing risk Stratification Assessments, greatly improving care management. Maintained record accuracy with precise clinical data entry.
• Efficiently managed expense tracking, ensuring precise documentation and approval of financial transactions.

Phoenix, Arizona, United States

• Demonstrated excellence in customer service, sales, collections, billing, and account management. Developed training materials, built strong client relationships, handled escalations, managed emails, and proficiently.
• Assisted in transition from Siebel to MAS operating systems.
• Developed job aides, billing training, sales training, and retention training for fellow co-workers.