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.

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.

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.