Natalie Ohiri
Randolph
Summary
Results-driven healthcare professional with extensive experience in provider relations and claims operations. Focused on fostering strong partnerships with major provider groups to effectively resolve operational challenges and enhance reimbursement processes.
Overview
11
11
years of professional experience
Work History
Provider Account Manager II
Point32Health
Canton
01.2022 - Current
- Developed and maintained strategic relationships with major provider groups, hospital systems, and vendor partners to support operational objectives
- Acted as the primary escalation point for complex provider operational and claims issues, aligning processes with contracts and improving business performance.
- Coordinated resolutions by collaborating with Claims, Contracting, Legal, Network, and Configuration teams, streamlining issue resolution processes
- Identify root causes, develop action plans, test solutions, and guide issues through resolution
- Lead internal and external meetings, including agenda development, documentation, and follow-up
Provider Account Manager
Tufts Health Plan
Watertown
01.2019 - 01.2022
- Conducted root cause analysis on claims denials and audits to identify trends and improve contract compliance
- Managed provider inquiries and escalated claim issues, preparing settlement recommendations to facilitate timely resolutions
- Developed leadership reports detailing findings and risks, providing actionable resolutions to enhance decision-making
Complex Claims Adjuster II
Tufts Health Plan
Watertown
01.2015 - 01.2019
- Adjusted complex inpatient and outpatient claims to ensure compliance with coding and state mandates, improving processing accuracy
- Managed escalated pricing, denial, and authorization inquiries to facilitate timely resolutions and maintain client satisfaction
- Facilitated training and provided team coverage support to enhance operational readiness and knowledge sharing
Education
Cosmetology License -
Blaine Beauty School
Boston, MAHigh School Diploma -
Cambridge Rindge and Latin School
Cambridge, MASkills
- Claims management
- Contract negotiation
- Incident management
- Root cause analysis
- ServiceNow
- Microsoft Office Suite
- Collaboration tools
- Cloud storage management
References
Available upon request.
Timeline
Provider Account Manager II
Point32Health
01.2022 - Current
Provider Account Manager
Tufts Health Plan
01.2019 - 01.2022
Complex Claims Adjuster II
Tufts Health Plan
01.2015 - 01.2019
Cosmetology License -
Blaine Beauty School
High School Diploma -
Cambridge Rindge and Latin School