Ryan Roy Email & Phone Number

Long Beach, California, Us

• Audits provider records for quality and financial accuracy, providing detailed, documented feedback.• Supports configuration issues and the loading of provider information in QNXT.• Assists in training both current staff and new hires as needed.• Generates and distributes network quality reports for assigned states (ID/UT/MI).• Produces provider-related reports to support Provider Services and facilitate Provider Problem Research & Resolution.• Leads the auditing process for the daily Sanctions report, ensuring accuracy for the Sanctions Team.• Contributes to the preparation of weekly Quality Metrics reports for the department.

Bloomfield, Ct, Us

• Provided internal support to the Physician/Provider Network team by researching and applying problem-solving skills to resolve provider and claims issues in the QNXT system.• Collaborated cross-functionally with claims, network operations, configuration, and enrollment teams to resolve a variety of provider and member issues.• Analyzed electronic data receipts and performed manual processing, including inputting provider data and contracts into supporting systems.• Researched and resolved claims flagged in the 101 error report to ensure proper adjudication.• Processed additions, terminations, and updates in the QNXT system to maintain network and contract integrity within Cigna Healthspring.• Presented recommendations to the Cigna Project Management team to optimize workflows and improve business procedures.• Compiled inventory reports and assigned tasks to the claims administration team to ensure efficient workflow.• Served as the Subject Matter Expert (SME) for PDM and Product Owner of adjudication projects, contributing to the creation of Business Requirements Documents (BRD).

Boca Raton, Florida, Us

• Primary oversight of furniture department.• Assist customers by providing guidance and information on products and services related to furniture, supplies, technology purchases, copy and print requests.• Maintain supply inventories and assist in developing store marketing strategies by way of signage and displays.• Proficient in register transactions to include basic purchases and returns.• Experience with Microsoft Suite applications and Adobe conversion and editing.

Us

• Responsible for conducting a high volume of outbound calls to members in order to schedule in-home visits with healthcare professionals.• Provided oversight and management of scheduled appointments to ensure departmental procedures were followed, scheduling issues were resolved and confirmation that scheduled visits occurred. • Answered inbound calls from members, assisting them with their inquiries.• Organized employee engagement events, boosting moral of assigned work team.

Us

• Ensured all UnitedHealthcare Community Plan of Maryland members were accurately assigned to active primary care providers in the claims platform.• Researched and resolved discrepancies in primary care provider data, coordinating corrective actions to address member and provider load errors for successful claim adjudication.• Managed member correspondence related to primary care provider issues, including scanning images and routing them to appropriate business areas via an online image routing system.• Provided training and guidance to multiple business segments, including claims, enrollment, and contracting teams.• Documented and presented trends identified during member assignment research to management for process improvements.• Supported work teams in submitting weekly reports to the State of Maryland Department of Mental Health and Hygiene, including claims platform and manual updates based on research findings.