Experience

Keller Williams Legacy Brokerage Group

• United States
• Real Estate
• 1 - 100 Employee

• Georgia REALTOR ®

  • Feb 2021 - Present

  Specializing in representing consumers in residential sales or purchases in the Northern suburbs & the North Georgia mountains.



Spoto & Associates, LLC

• Senior Consultant

  • Jul 2012 - Feb 2021

  Contract development and direct negotiations with commercial payors and self-insured employers on behalf of hospital clients. Products include PPO, HMO, Medicare, Medicaid, and behavioral health.



Coventry Health Care

• Facility Contract Consultant

  • Apr 2011 - Oct 2011

  Ongoing network analysis for all contracts pertaining to fully insured, ASO, HMO, PPO, leased, Workers Compensation, and Medicare products. Recruited and contracted hospitals, physicians, and ancillary services. Cost/market analysis. Maintained working relationships within the existing network. Liaison for escalated claims inquiries.Accomplishments: HMO contract expansion with three key hospital and physician groups.Stabilized major contract under term notice, resolved operational issues, and expanded contract into HMO product.



Cigna

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Assistant Director, Provider Contracting

  • Jun 2008 - Jun 2010

  Focus on building new, and underdeveloped, markets. Created business plans relating to network configuration and medical cost targets.• Performed market/provider analysis, closed sales, developed comprehensive contract proposals and negotiated agreements which reduced delivery costs, expanded and enhanced networks, and created opportunities for increased sales.• Met and exceeded, medical cost targets assigned to each assigned contract by developing and maintaining positive relationships with assigned hospitals, physicians and ancillary providers.• Coordinated and led education and provider forums that improved provider contract/policy compliance.• Tracked project deliverable's and met assigned target dates.



Anthem Blue Cross/Blue Shield of Georgia

• Sr. Contract Manager

  • Jul 2006 - Jun 2008

  Hospital Account & Contract Manager for multiple markets. Network liaison for sales & broker affiliates with focus on access, cost, and service level success. Effectively managed multiple contracting projects attached to Corporate Payment for Performance initiatives. • Project Manager for statewide post payment audit initiative. Developed the project scope/plan, built cross-functional teams including an IT component. Successfully implemented, met deadlines, and increased Plan savings year over year. My project was identified as “Best in Practice” by Anthem and is used as a guideline for future audit projects.• Account Manager for designated markets and accounts for all operational, contractual, and pricing challenges. Resolved contractual complaints by educating the provider on the correct interpretation and/or identifying problems and working with necessary internal customers to reach resolution. This improved customer relationships and increased success in future negotiations. • Managed Joint Operation Committee Meetings between provider accounts and company staff by identifying agenda items and arranging for attendance by appropriate personnel to ensure timely resolutions. • Facilitated the achievement of corporate cost of care initiatives by consistently auditing contract content compared to policy and negotiating when necessary. Tracked internal performance metrics against policy and worked with the provider to improve accuracy and success.



Private Healthcare Systems

• Network Development Executive

  • Jan 1994 - Jan 2006

  Performed as a multi-disciplined contract negotiator/network developer, providing for financial analysis, planning and reporting. Promoted multiple times during employment as recognition of accomplishments. Developed and maintained provider relationships by consistently anticipating their needs and concerns and reliably providing deliverable solutions.Developed and documented a successful approach to network development that was headlined in an internal publication & distributed nationally.Provided project management for five states pertaining to physician reimbursement and directed nine executive contractors, exceeding corporate objectives every year and reducing reimbursement expenses by $94M.Increased in-network utilization, saving $6.1M in two years by aggressively contracting with non-participating key providers. Reduced hospital inpatient costs over two years with a savings of $7.3M by re-negotiating the financial terms with high volume providers.

• Network Development Executive

  • 1994 - 2006



Ear, Nose & Throat Associates, PC

• Manager

  • Jan 1989 - Jan 1993

  Managed the revenue cycle for the President and two high-producing surgeons. Provided comprehensive surgical case management and consulted with potential surgical candidates regarding expectations and financial responsibilities. Researched and executed all necessary payer requirements to ensure financial compliance.