Courtney Quezerque
Parkton
Summary
With eight years of experience in health administration, a dynamic and results-driven professional. Expertise in cultivating strong provider relationships and promoting multi-disciplinary collaboration. Proven track record in conducting comprehensive investigations, analyzing data, and delivering actionable insights to drive organizational success. Seeking to leverage background in provider relations and analytical problem-solving to contribute to a challenging role as a Provider Network Manager.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Provider Relations Coordinator
Provider Partners Health Plan
06.2023 - Current
- Spearheading the credentialing process for diverse provider groups and facilities
- Conduct proactive outreach to providers via email and ticket resolution
- Negotiate agreements and rates to enhance organizational partnerships
- Identifying providers the plan needs and outreach for agreements so that optimize member access to specialized care
- Analyze claims data to detect and address fraudulent billing trends
- Conducting detailed reviews of spreadsheets and entering accurate data for facilities and providers to ensure data integrity and support and operational efficiency
- Resolving time-sensitive member issues, including addressing provider non par status and appointment cancellations for critical care, to ensure continuity of care and minimize disruptions for members
Provider Relations Coordinator
Provider Partners Health Plan
06.2023 - Current
- Spearheading the credentialing process for diverse provider groups and facilities
- Conduct proactive outreach to providers via email and ticket resolution
- Negotiate agreements and rates to enhance organizational partnerships
- Identifying providers the plan needs and outreach for agreements so that optimize member access to specialized care
- Analyze claims data to detect and address fraudulent billing trends
- Conducting detailed reviews of spreadsheets and entering accurate data for facilities and providers to ensure data integrity and support and operational efficiency
- Resolving time-sensitive member issues, including addressing provider non par status and appointment cancellations for critical care, to ensure continuity of care and minimize disruptions for members
Senior Provider Relations Coordinator
Carolina Complete Health Network, Inc
01.2021 - 06.2023
- Lead a team in efficiently resolving state complaints and tickets
- Safeguard confidential business information and effectively communicate provider issues and changes
- Serve as a key liaison between providers, health plan, and other stakeholders
- Ensure compliance with HIPAA and organizational information security standards
- Assist in policy development and implementation related to provider relations
- Provide guidance on contracting, claims management, and provider education initiatives
- Oversee provider credentialing process and manage inbound/outbound communications
- Handle escalated provider issues and conduct team training sessions
Senior Provider Relations Coordinator
Carolina Complete Health Network, Inc
01.2021 - 06.2023
- Lead a team in efficiently resolving state complaints and tickets
- Safeguard confidential business information and effectively communicate provider issues and changes
- Serve as a key liaison between providers, health plan, and other stakeholders
- Ensure compliance with HIPAA and organizational information security standards
- Assist in policy development and implementation related to provider relations
- Provide guidance on contracting, claims management, and provider education initiatives
- Oversee provider credentialing process and manage inbound/outbound communications
- Handle escalated provider issues and conduct team training sessions
UM Technician
AmeriHealth Caritas
10.2021 - 01.2022
- Support daily operations of the Utilization Management team, interacting with staff, facilities, vendors, and providers
- Maintain expertise in Utilization Management processes and timelines
- Conduct outreach calls and collect data under established protocols
- Process authorizations and referrals, ensuring compliance with guidelines
- Handle incoming calls from members and providers professionally
- Maintain HIPAA confidentiality standards and adhere to company policies
UM Technician
AmeriHealth Caritas
10.2021 - 01.2022
- Support daily operations of the Utilization Management team, interacting with staff, facilities, vendors, and providers
- Maintain expertise in Utilization Management processes and timelines
- Conduct outreach calls and collect data under established protocols
- Process authorizations and referrals, ensuring compliance with guidelines
- Handle incoming calls from members and providers professionally
- Maintain HIPAA confidentiality standards and adhere to company policies
Member Services Representative
Santa Barbara
04.2019 - 07.2021
- Respond to member inquiries regarding plan benefits, coverage, and claims status via phone, email, or chat
- Assist members with enrollment, updates to personal information, and selecting or changing health plans
- Resolve billing and payment issues, ensuring accurate processing of member accounts
- Provide guidance on understanding health insurance terminology, policies, and procedures
- Investigate and resolve member complaints or concerns related to claims, benefits, or service
- Educate members on available services, preventive care, and network providers
- Process claims inquiries, verifying coverage and eligibility for services
- Maintain accurate and up-to-date member records in company systems
- Collaborate with other departments to address complex issues and ensure customer satisfaction
Member Services Representative
Santa Barbara
04.2019 - 07.2021
- Respond to member inquiries regarding plan benefits, coverage, and claims status via phone, email, or chat
- Assist members with enrollment, updates to personal information, and selecting or changing health plans
- Resolve billing and payment issues, ensuring accurate processing of member accounts
- Provide guidance on understanding health insurance terminology, policies, and procedures
- Investigate and resolve member complaints or concerns related to claims, benefits, or service
- Educate members on available services, preventive care, and network providers
- Process claims inquiries, verifying coverage and eligibility for services
- Maintain accurate and up-to-date member records in company systems
- Collaborate with other departments to address complex issues and ensure customer satisfaction
Temporary Employee - Claims Liaison Representative
CenCal Health
11.2018 - 04.2019
- Assist with claims processing and provide explanations to healthcare providers
- Facilitate communication between providers and insurance companies
- Initiate and follow up on check tracers to ensure timely resolution
Temporary Employee - Claims Liaison Representative
CenCal Health
11.2018 - 04.2019
- Assist with claims processing and provide explanations to healthcare providers
- Facilitate communication between providers and insurance companies
- Initiate and follow up on check tracers to ensure timely resolution
Flight Attendant
Mesa Airlines
07.2007 - 08.2009
- Ensure passenger safety through pre-flight demonstrations and adherence to safety protocols
- Provide exceptional customer service, addressing passenger needs and ensuring a comfortable flight experience
- Serve food, beverages, and manage special requests, ensuring compliance with dietary restrictions
- Assist with boarding, seating, and deplaning, ensuring efficient passenger flow
- Handle in-flight emergencies and resolve passenger concerns with professionalism
- Monitor cabin conditions, restock supplies, and maintain a clean environment
- Provide flight information and assist with connecting flights or travel inquiries
- Adhere to airline policies and ensure safety and security standards are met
Flight Attendant
Mesa Airlines
07.2007 - 08.2009
- Ensure passenger safety through pre-flight demonstrations and adherence to safety protocols
- Provide exceptional customer service, addressing passenger needs and ensuring a comfortable flight experience
- Serve food, beverages, and manage special requests, ensuring compliance with dietary restrictions
- Assist with boarding, seating, and deplaning, ensuring efficient passenger flow
- Handle in-flight emergencies and resolve passenger concerns with professionalism
- Monitor cabin conditions, restock supplies, and maintain a clean environment
- Provide flight information and assist with connecting flights or travel inquiries
- Adhere to airline policies and ensure safety and security standards are met
Education
Master of Business Administration - Management
Louisiana State University
04.2025
Bachelor of Science - Health Administration
University of Phoenix
09.2018
Associates of Arts - Foundations in Health Administration
University of Phoenix-Online Campus
06.2015
Skills
- Task Delegation
- Project Management
- Quality Assurance
- Data Management
- Computer Literacy (Microsoft Word, Excel, PowerPoint)
- EHR and EMR Literacy
- Managed Care
- Medical Billing and Coding (CPT, ICD-10)
Certification
First Aid Certification
Timeline
Provider Relations Coordinator
Provider Partners Health Plan
06.2023 - Current
Provider Relations Coordinator
Provider Partners Health Plan
06.2023 - Current
UM Technician
AmeriHealth Caritas
10.2021 - 01.2022
UM Technician
AmeriHealth Caritas
10.2021 - 01.2022
Senior Provider Relations Coordinator
Carolina Complete Health Network, Inc
01.2021 - 06.2023
Senior Provider Relations Coordinator
Carolina Complete Health Network, Inc
01.2021 - 06.2023
Member Services Representative
Santa Barbara
04.2019 - 07.2021
Member Services Representative
Santa Barbara
04.2019 - 07.2021
Temporary Employee - Claims Liaison Representative
CenCal Health
11.2018 - 04.2019
Temporary Employee - Claims Liaison Representative
CenCal Health
11.2018 - 04.2019
Flight Attendant
Mesa Airlines
07.2007 - 08.2009
Flight Attendant
Mesa Airlines
07.2007 - 08.2009
Master of Business Administration - Management
Louisiana State University
Bachelor of Science - Health Administration
University of Phoenix
Associates of Arts - Foundations in Health Administration
University of Phoenix-Online Campus
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