Currently Available for contracted managed care payer/provider contracting consulting opportunities. Let our team at City By the Sea Consulting build your new provider network. We are a team of top... show more
Currently Available for contracted managed care payer/provider contracting consulting opportunities. Let our team at City By the Sea Consulting build your new provider network. We are a team of top notch contractors with proven results that are ready for your new build. Specializing in Contracting and Network Development. Provider Recruitment , network expansions, , Contracting and rate negotiations. Prefer to work remotely, but will consider travel. Specialties: Special projects. Physician Credentialing, Provider Recruitment., Contracting, Amendment projects, LOI's. Network Development and expansion projects. Contract and rate negotiations, Medical Office Management, Marketing, , medical billing, Excel, , Microsoft word, presentation skills, Provider Relations, problem solving, recruiting, , supervisory skills, typing, Seeking new opportunities for: - Physician or Direct Payer contracting/credentialing/negotiation support - Provider Directory Audits/ Corrections / Quality checks - Contract Negotiation - Hospital contracting - Missing Credentialing / Contract Scrubbing - Dashboard and Reporting
Praises help jobseekers showcase strengths and stand out to employers.
Successfully completed numerous large network development initiatives and expansion projects.
*Completed a Multi-state Medicare Advantage Plan recruitment initiative
*Part of a team that expanded a major Medicaid MCO network, as well as Medicare Advantage Plans in the New York, New Jersey area.
*Developed two FIDA and a DD network as well as several Health Exchange Networks in the NY upstate and downstate areas.
*Accomplishments included creating several SNP networks and a DD network in NY.
*Highest producer on the team at Mazars, earned an IPAD in 2013.
*Met all assigned goals, priority assignments, creating marketing tools, project reports, and filled all my gaps in the network for each assignment.
*Ensured all contracting and credentialing documents were received and current
Several Medicaid and Medicare Advantage Plan builds and expansions
*Researched all provider leads
*Analyzed data to support contract negotiations
*Identified all gaps in network as well as completing strategy documents
*Health Care Provider recruitment and Network Development
*Completely built Medicare Advantage SNP (ESRD) network in a few counties, in several states, TX, AZ, PA, MO and worked gaps for a couple additional counties.
*Negotiated a great deal for the ESRD for a large Podiatry as well as two SNF networks with over 17 facilities.
*Recruited a mental health network of 223 providers.
*2012 Created a SNP network and a DD network in NY.
*2011, for Maryland and Capital/DC area I worked on an MCO/ Medicare Advantage network, ASC network expansion as well as an expansion to their Sleep Center network by over 30%, which translated into over $300,00 savings per year for the client
Completed a Medicaid and Medicare expansion and gap project for IL and IN.
*Filled all gaps and completed all assignments including hospital contracting and negotiations.
*Accomplishments included contracting several psychiatric hospitals as well as the entire Deaconess Health system.
Completed several large network development and network expansion projects for a few major Medicaid MCO's.
*Developed and expanded networks for major health plans.
*Recruitment and contract negotiations with Ambulatory Surgery Centers, (ASC's) physicians, provider groups, ancillary providers, IPA's and Health Centers
*Met all deadlines, filled all required network gaps.
*Prepared reports for gap analysis, analyzing data to support contract negotiations, and identified all gaps in network as well as completing strategy documents. .
*Credentialing for large hospital groups, provider groups and ancillary providers- which included negotiating rates with health plans for those providers
*Knowledge of contractual language, the credentialing process and application process.
*Created Medicaid networks in several counties in Tennessee, Ohio, Maryland, and Arizona, as well as NYC Metro area.
*Provided Provider Relations support as needed.
*Negotiated rates with providers and with health plans, per diem rates, revenue codes and CPT coding per CMS fee schedule.\ Obtained all documents with completed applications for submission, as well as credentialing documents.
*Met all assigned goals, priority assignments, and filled all gaps in the network for each assignment.
Educated providers on the protocols of the plan. Conducted site visits for credentialing purposes. Maintained strong and positive relationships with physicians and their office staff. Analyzed the network for any deficiencies to ensure adequate specialty networks. Headed the EVR pilot project. Ensured all members in my territory were contacted regarding mammography initiative. Tracking, reporting and responding to provider issues. Resolving claims, authorization and capitation payment issues in a timely fashion, as necessary.
Established and maintained initial and on-going provider education, including products, referral protocols and claims submissions. Conducted HEDIS audits, assisted credentialing department obtaining all documentation, supporting paperwork. Proven ability to meet deadlines. Prioritized projects, and handled multiple tasks. Planned and coordinated Marketing Events, senior dances, health fairs .Presentations at Senior Wellness Seminars, Health Fairs and Medicare recruitment and enrollment events. Trained new employees. Physician recruitment. Created education materials
for the department, conducted Provider Orientations and Site visits as well as, Power Point presentations. Retention Specialist. Worked in the field with 75% of local travel.
EMPLOYEE OF THE MONTH JULY 2001, EMPLOYEE OF THE YEAR 2002
Prior to 1998 I worked as a Billing Manager/Office Manager for a few Orthopedic Surgeons. This experience has been integral to my move to Network Development.