1. J. Renay Akhemien - https://www.linkedin.com/pub/renay-akhemien/46/790/9ab
HEALTHCARE PROFESSIONAL SEEKING VALUABLE, GROWTH-ORIENTED HEALTH CARE SUPPORTROLE
926 W. Philadelphia St. Unit 75 • Ontario, CA 91762 • (310) 908-0673 • j.renayakhemien@yahoo.com
Passionate M.S. in Public Health candidate eager to offer exceptional professional healthcare experience. Excellent
communicator who seamlessly interfaces with clinicians, executives, peers, and patient clientele.
PROFILE OF QUALIFICATIONS
ADMINISTRATIVE SUPPORT • HEALTHCARE OPERATIONS • PATIENT RELATIONS • MEDICARE REIMBURSEMENT •
MANAGED CARE OPERATIONS •PROVIDERRELATIONS•MEDICAL TERMINOLOGY • PROVIDER CLAIMS RESOLUTION •
HIPAA COMPLIANCE •PROVIDER OPERATIONS •HEALTH PLANLINE OF BUSINESS:HMO/POS/PPO/EPO •DATABASE
MANAGEMENT
 Integral team player who plans, prioritizes, and completes various tasks within fast-paced environments.
 Highly analytical individual possessing the ability to make quality timely decisions.
 Value added to what is currently trending in healthcare with creativity and forward thinking.
 Solutions-focused professional who offers a quick-learning nature to succeed in diverse healthcare areas.
PROFESSIONALSYNOPSIS
Provider Relations Specialist
UCLA HEALTH, LOS ANGELES, CA JUNE 2012 - PRESENT
 Maintain patient/member confidentiality to satisfy HIPAA guidelines and regulations with regards to patient health
information (PHI).
 Maintain monthly provider reports which are disseminated to the Health Plans indicating any changes or updates in
provider status with UCLA Medical Group.
 Responsible for educating office staff and providers on Division of Financial Responsibility (DOFR) between
UCLAMG and the contracted Health Plans.
 Conduct provider orientations; communicate policies and procedures and regulatory compliance matters as it directly
impacts the clinicians and office personnel.
 Educate provider/members on currently active contracts with the Health Plan and the specific Lines of Business
(HMO, PPO, POS & EPO).
 Intermediary between UCLAMG, the Health Plans and the contracted provider network to actively research and
resolve provider complaints and contractual concerns/issues.
 Resolve administrative problems affecting network providers, patients and plans within contracted guidelines for
which the network is responsible.
Lead Provider Operations Coordinator
UCLA HEALTH, LOS ANGELES, CA MAY 2003 – JUNE 2012
 Liaison between Claims, Membership Eligibility, Utilization Management, Quality Team, Provider Relations & Benefits
departments with regards to providers, members, benefits, contracted vendors and pricing updates.
 Contract analysis of all active contracts with the Health Plan and the specific Lines of Business across all markets
(HMO, PPO, POS & EPO).
 Maintained and updated system database for provider and vendor records for contractual purposes to facilitate the
electronic database interface (EDI) for eligibility and claims.
 Provided weekly reports on claims EDI, provider invalid, provider not found & pricing reports.
 Create, update & revised Provider Operations policies & procedure guidelines.

2. Lead Provider Representative/Provider Relations
UNITED HEALTHCARE, LONG BEACH, CA JULY 2000 – MAY 2003
 Trained new hires on system, policy & procedure, as well as workflow management.
 Performed data maintenance including participating/non-participating providers’ demographic panels including but not
limited to changing, adding or deleting information.
 Worked directly with off-site ancillary providernetwork in various markets (Hawaii, Texas, Washington, New York &
Michigan.
 Educated providers and clinical staff on company policy & procedures for member safety and quality of care.
EDUCATION &TECHNICALSUMMARY
Master of Science in Healthcare (Public Health Emphasis, Projected 2017)
SOUTHERN NEW HAMPSHIRE UNIVERSITY, MANCHESTER, NH
Bachelor of Science in Healthcare Administration/Healthcare Management (3.85 GPA)
UNIVERSITY OF PHOENIX, PHOENIX, AZ
Participant, Susan G. Komen Race for a cure (Since 2009)
Participant, Lupus Together – Support Group (Since 2010)
Microsoft Office (Word, Excel, Access & PowerPoint) • Epic • Morrissey • Microsoft Windows 8 • Types 85+ WPM