April Fox
Gilbert
Summary
Results-driven Provider Relations Manager skilled in relationship building, problem resolution, and training facilitation. Proven ability to enhance provider engagement and service delivery.
Overview
8
8
years of professional experience
Work History
Provider Relations Manager
Evolent
Arlington
08.2025 - Current
- Cultivated relationships with healthcare providers to strengthen collaboration and communication.
- Coordinated provider onboarding processes for seamless network integration.
- Facilitated training sessions on new policies and procedures for providers.
- Managed provider inquiries and resolved issues promptly.
- Developed educational materials to support provider engagement initiatives.
- Analyzed feedback from providers to enhance service delivery.
- Collaborated with cross-functional teams to optimize operational workflows.
- Implemented strategies to boost provider participation in quality improvement programs.
Provider Relations Manager
Cigna Health Care
Gilbert
07.2023 - 03.2025
- Implemented quality control measures to uphold company standards.
- Analyzed business performance data and forecasted business results for upper management.
- Organized team activities to build camaraderie and foster pleasant workplace culture.
- Mediated conflicts between employees and facilitated effective resolutions to disputes.
- Evaluated individual and team business performance and identified opportunities for improvement.
- Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
- Fostered relationships with healthcare providers to enhance collaboration and communication.
- Managed provider inquiries and resolved issues in a timely manner.
- Developed educational materials to support provider engagement initiatives.
- Analyzed feedback from providers to improve service delivery and satisfaction.
- Implemented strategies to enhance provider participation in quality improvement programs.
- Responded promptly to inquiries from providers regarding billing issues, claims processing.
- Prepared reports on provider relations activities for management review.
- Assisted in the development of incentive programs designed to drive improved quality outcomes.
Provider Relations Manager
Centene
Tempe
05.2018 - 07.2023
- Analyzed business performance data and forecasted business results for upper management.
- Proposed or approved modifications to project plans.
- Implemented quality control measures to uphold company standards.
- Mediated conflicts between employees and facilitated effective resolutions to disputes.
- Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
- Assigned work and monitored performance of project personnel.
- Reviewed completed work to verify consistency, quality, and conformance.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Delegated work to staff, setting priorities and goals.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Developed presentations outlining changes in reimbursement policy or procedure updates.
- Monitored claim denials, appeals, and grievances for accuracy and completeness of information.
- Coordinated the resolution of complex provider disputes by working closely with internal stakeholders.
- Participated in meetings with external parties such as managed care organizations and other vendors.
- Researched provider inquiries and responded timely in a professional manner.
- Conducted site visits to assess provider performance against contractual requirements.
- Reviewed invoices from vendors providing services related to Provider Relations functions.
- Analyzed provider contracts to identify areas of improvement or potential risk exposure.
- Ensured all new providers met credentialing criteria prior to onboarding.
- Coordinated provider onboarding processes to ensure seamless integration into the network.
- Facilitated training sessions for providers on new policies and procedures.
- Managed provider inquiries and resolved issues in a timely manner.
- Developed educational materials to support provider engagement initiatives.
- Analyzed feedback from providers to improve service delivery and satisfaction.
Education
High School Diploma -
Central Valley High School
Shasta Lake, CA06-1998
Skills
- Provider engagement
- Quality improvement
- Onboarding processes
- Conflict resolution
- Training facilitation
- Data analysis
- Healthcare management
- Relationship management
- Cross-functional collaboration
- Effective communication
- Problem solving
- Team building
- Time management
- Educational material development
- Member enrollment
- Provider orientations
- Health plan operations
- Provider relationship management
- Educational presentations
- Strategic business relationships
- On-site visits
- Healthcare industry
- Organizational skills
- Workflow Analysis
- Verbal and written communication
- Interpersonal skills
- Documentation and reporting
- Managing operations and efficiency
- Process optimization
- Professional and courteous
- Complex Problem-solving
- Customer relations
- Business analysis and reporting
Timeline
Provider Relations Manager
Evolent
08.2025 - Current
Provider Relations Manager
Cigna Health Care
07.2023 - 03.2025
Provider Relations Manager
Centene
05.2018 - 07.2023
High School Diploma -
Central Valley High School