Kytrania Young

Established collaborative relationships that enhanced coordination between plans and contracted providers.

• Identifies topics and performs in-services” with frequency as specified by Department standards, for providers for the purpose of communicating policy changes, gathering or presenting statistical and financial data and promoting positive working relationships.
• Educates providers on all applicable incentive programs.
• Conducts service calls as requested by provider or PLAN staff member within the time period specified by Department standards.
• Addresses routine inquiries without dependency on supervisor, but can distinguish those issues for which direct response is inappropriate and immediately apprises manager. Functions as an account leader for assigned providers.
• Develops positive working relationships with applicable provider practice staff.
• Understands Plan reports and metrics and uses them to evaluate the performance of assigned practices.
• Meets with assigned practices to present data outlining their performance, promoting established performance standards.
• Coordinates the Joint Operating Committee (JOC) meeting.
• Schedules meetings at provider’s convenience demonstrating reasonable flexibility in adjusting schedule for appointments.
• Supports the Quality Management Department with the credentialing and re-credentialing process, and the investigation of member complaints and potential quality Issues.
• Demonstrates a functionally working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department.
• Support contracting for multiple product lines
• Facilitated the implementation of advanced completed contracts to streamline operational processes.
• Managed multiple accounts simultaneously while maintaining organization and prioritizing tasks efficiently.
• Applied comprehensive understanding to formulate and present compelling claims.

Responded to provider inquiries and needs while providing training to ensure effective utilization of services within the provider network.

• Responsible for the accuracy and timely management of the assigned territory provider contracts
• Meets with assigned practices to present data outlining their performance, promoting established performance standards.
• Educates providers on all applicable incentive programs.
• Executed service calls as requested by providers or plan staff members, adhering to departmental time standards.
• Obtains documentation required for credentialing for credentialing or re-credentialing of providers as requested.
• Completes requests for investigation of member complaints within time period specified by Department standards.