Michael Tran

Houston, TX

(713) 555-1842

michael.tran92@gmail.com

linkedin.com/in/michaeltran92

SUMMARY

Results-driven Managed Care Coordinator with 1+ years of experience in care coordination, member assessment, and data management within healthcare services. Proven record of improving documentation timeliness by 100% compliance with submission standards. Expertise in Guiding Care systems and Excel reporting to optimize operational workflows, mitigate documentation errors, and drive coordinated member outcomes.

SKILLS

Guiding Care

Excel Reporting

Data Entry

Provider Outreach

Care Coordination

Compliance Tracking

EXPERIENCE

Care Coordination Assistant

Lone Star Health Services, Houston, TX

June 2024 – Present

• Processed 35+ weekly care plan documents, uploading Case Conference notes within two business days and achieving 100% compliance with documentation timelines
• Generated outpatient authorization shells for 25+ cases weekly, reducing processing delays by 15% and improving care manager workflow efficiency
• Distributed Welcome Packages to PCP offices and confirmed receipt for 90% of cases, strengthening provider communication and onboarding processes
• Uploaded 50+ member consent forms monthly with zero audit discrepancies, ensuring full compliance with documentation standards

Administrative Support Specialist

Bayview Community Health, Houston, TX

January 2023 – May 2024

• Contacted provider offices to request lab results for 30+ members weekly, improving turnaround time for clinical data retrieval by 20%
• Prepared weekly Excel reports tracking operational metrics, enabling management to monitor performance trends and improve team productivity by 10%
• Researched 40+ providers monthly using internal directories, supporting member referrals and expanding access to appropriate care services
• Coordinated supply mailings for 25+ members weekly, enhancing member engagement and adherence to care plans

EDUCATION

Associate Degree in Health Administration

Houston Community College, Houston, TX

Jessica Alvarez

Phoenix, AZ

(602) 555-7719

j.alvarez.health@gmail.com

linkedin.com/in/jessica-alvarez-health

SUMMARY

Results-driven Managed Care Coordinator with 4+ years of experience in provider enrollment, care coordination, and contract support within healthcare operations. Proven record of reducing enrollment delays by 20% through improved tracking and reporting processes. Expertise in credentialing systems and Excel modeling to optimize provider onboarding, mitigate compliance risks, and drive revenue cycle efficiency.

SKILLS

Provider Enrollment

Credentialing Systems

Excel Reporting

Compliance Auditing

Payer Coordination

Data Management

EXPERIENCE

Managed Care Coordinator

Desert Valley Health Network, Phoenix, AZ

March 2023 – Present

• Managed credentialing database for 100+ providers, maintaining accurate, effective dates and ensuring continuous active payer status across Medicare, Medicaid, and commercial plans
• Developed Excel-based tracking reports used by leadership, reducing enrollment processing delays by 20% and improving provider start-date visibility
• Coordinated provider onboarding and enrollment processes, resolving 20+ issues quarterly and accelerating revenue-generating readiness timelines
• Verified licenses and certifications across multiple markets, achieving 98% compliance with regulatory and accreditation standards

Care Coordination Specialist

Southwest Community Care, Phoenix, AZ

May 2021 – February 2023

• Conducted 40+ weekly member assessments using standardized tools, supporting accurate identification of care needs and program eligibility
• Screened members for high-risk conditions, escalating 25% of cases to clinical teams and improving prioritization of care interventions
• Coordinated services for 60+ active members, optimizing utilization and reducing unnecessary service costs by 12%
• Established individualized care goals with members and caregivers, improving engagement and adherence rates across chronic care populations

EDUCATION

Bachelor of Science in Healthcare Administration

Arizona State University, Tempe, AZ

Christopher D. Bennett

Chicago, IL

(312) 555-9021

chris.bennett.mcoordinator@gmail.com

linkedin.com/in/christopherdbennett

PROFESSIONAL SUMMARY

Results-driven Managed Care Coordinator with 8+ years of experience in managed care analysis, provider enrollment, and contract coordination within integrated healthcare systems. Proven record of improving reimbursement readiness by 25% through optimized credentialing and reporting processes. Expertise in financial modeling and payer analytics to optimize contract performance, mitigate revenue risk, and drive operational alignment across multi-site healthcare networks.

CORE SKILLS

Payer Analytics

Contract Modeling

Credentialing Systems

Excel Reporting

Compliance Auditing

Provider Relations

EXPERIENCE

Senior Managed Care Coordinator

Midwest Integrated Health Group, Chicago, IL

January 2022 – Present

• Directed provider enrollment and credentialing for 150+ providers, ensuring uninterrupted payer participation and reducing revenue disruption incidents by 25%
• Developed standardized reporting frameworks for executive leadership, improving enrollment visibility and accelerating provider onboarding timelines by 20%
• Coordinated cross-functional efforts with directors and administrators to add new services and locations under existing contracts, supporting revenue expansion initiatives
• Analyzed enrollment and payer issues, resolving 30+ complex cases annually and improving provider reimbursement timelines

Managed Care Analyst

Great Lakes Health Services, Chicago, IL

June 2018 – December 2021

• Evaluated financial and operational performance across 40+ payer contracts, improving margin visibility and supporting strategic contract negotiations
• Modeled reimbursement scenarios using Excel-based pro formas, increasing forecasting accuracy by 18% and informing leadership decision-making
• Presented contract risks and recommendations to senior stakeholders, influencing payer strategies and improving contract approval outcomes
• Maintained rate files and performed variance analysis, enhancing data integrity and supporting ongoing contract performance monitoring

EDUCATION

Bachelor of Science in Health Systems Management

University of Illinois Chicago, Chicago, IL

• Conducted managed care data analysis by identifying leadership reporting needs, extracting insights using Excel and Tableau, and delivering actionable reports that informed financial and operational decisions across multiple service lines.
• Evaluated financial, contractual, and operational performance for 25+ payer agreements, including correctional, behavioral health, and hospice contracts, improving margin visibility and supporting strategic payer mix decisions.
• Modeled reimbursement scenarios and contract terms using Excel-based pro formas and variance analyses, increasing forecasting accuracy by 18% and enabling leadership to assess financial risk before agreement execution.
• Presented contract risks and negotiation challenges to senior health system stakeholders, synthesizing complex financial data into clear recommendations that influenced payer strategy and contract approval outcomes.
• Collaborated with cross-functional subject matter experts to resolve 15+ contracting barriers annually, leveraging internal data sources and negotiation frameworks to strengthen contract terms and ensure regulatory compliance.
• Maintained and updated comprehensive rate files supporting over 40 active contracts, improving data integrity for variance tracking, provider relations issue resolution, and ongoing contract performance monitoring.

Core Skills:

• Contract Modeling
• Financial Analysis
• Excel Modeling
• Tableau Reporting
• Rate Management
• Payer Analytics

• Processed care plan documentation by uploading Case Conference notes into Guiding Care within two business days, ensuring 100% compliance with documentation standards and timely care coordination workflows.
• Generated outpatient authorization shells in Guiding Care for 30+ weekly cases, notifying care managers promptly to accelerate service approvals and reduce administrative processing delays.
• Assembled and distributed Welcome Packages to primary care providers, confirming receipt through direct outreach and improving onboarding communication efficiency across 95% of assigned member cases.
• Uploaded member consent forms into Guiding Care with strict accuracy, maintaining regulatory compliance and ensuring complete documentation for audits and care management continuity.
• Contacted provider offices to request laboratory results and coordinated supply mailings to members, supporting timely clinical decision-making and improving member engagement across diverse care plans.
• Prepared weekly Excel-based performance reports for management, tracking key operational metrics and incorporating supervisor feedback to consistently meet evolving quality and productivity standards.

Core Skills:

• Guiding Care
• Excel Reporting
• Authorization Setup
• Data Entry
• Provider Outreach
• Compliance Tracking

• Guided providers through end-to-end credentialing and enrollment processes across Medicare, Medicaid, and commercial payers, serving as a concierge liaison to streamline onboarding and reduce enrollment turnaround times by 20%.
• Maintained and monitored credentialing databases with accurate, effective dates for 100+ providers, ensuring continuous active status across managed care contracts and preventing disruptions to reimbursement cycles.
• Verified licensure and certifications across multiple markets, achieving 98% compliance with regulatory and accreditation standards while mitigating risk of payer denials and credentialing lapses.
• Tracked registration packet completion and escalated discrepancies to hiring managers, resolving 25+ enrollment issues quarterly and accelerating provider readiness for revenue-generating activities.
• Developed standardized reporting frameworks in Excel to communicate enrollment status to executives, enabling proactive start-date planning and reducing potential revenue loss across multiple service lines.
• Collaborated with cross-functional leadership to add new providers, locations, and services under existing contracts, analyzing payer requirements and resolving complex enrollment barriers impacting timely provider reimbursement.

Core Skills:

• Provider Enrollment
• Credentialing Systems
• Excel Reporting
• Compliance Auditing
• Payer Coordination
• Data Management

• Conducted telephonic and in-person member assessments using standardized tools to identify care needs, completing 40+ weekly evaluations that supported accurate program placement and service coordination.
• Screened members for potential high-risk conditions using predefined criteria, flagging 25% of cases for clinical team review to prevent complications and improve care prioritization.
• Coordinated member cases with interdisciplinary healthcare teams, ensuring seamless communication and timely support services for individuals with chronic conditions and complex non-clinical needs.
• Managed non-clinical care requirements for 60+ active members, optimizing service utilization and reducing unnecessary costs through efficient coordination of community and healthcare resources.
• Established individualized short- and long-term care goals with members and caregivers, increasing engagement and adherence to care plans across diverse populations with co-morbidities and disabilities.
• Identified opportunities for expanded services by analyzing member needs and utilization patterns, contributing to improved access to support programs and enhanced overall care outcomes.

Core Skills:

• Care Coordination
• Risk Screening
• Member Assessment
• Case Management
• Utilization Review
• Interdisciplinary Support