Experience

Universal Health Systems

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Community Liaison

  • Sep 2023 - Present

  Virginia, United States



The Felton Foundation

• United States
• Investment Management

• Chief Executive Officer

  • Nov 2022 - Present

  Washington DC-Baltimore Area



Johns Hopkins HealthCare

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Provider Engagement Liaison

  • Mar 2017 - Jan 2023

  Glen Burnie, Maryland As a Provider Engagement Liaison, I spearheaded a fusion of duties between external provider engagement representatives and internal provider relations representatives, effectively boosting our Provider Relationships and Network Performance. Additionally, continuous engagement with the community for the dissemination and explanation of quality, efficiency and financial performance data including but not limited to HEDIS/VBP/STARS reports, Patient Centered Medical Home (PCMH) program, utilizing… Show more As a Provider Engagement Liaison, I spearheaded a fusion of duties between external provider engagement representatives and internal provider relations representatives, effectively boosting our Provider Relationships and Network Performance. Additionally, continuous engagement with the community for the dissemination and explanation of quality, efficiency and financial performance data including but not limited to HEDIS/VBP/STARS reports, Patient Centered Medical Home (PCMH) program, utilizing applications and analytical reporting to maximize quality and cost of care improvements for plan members for the purposes of risk adjustment. Notably, this role entailed achieving significant Clinical and Affordability Targeted Improvements as per the identified objectives. My management skills were further honed as I successfully deployed the Medicaid National Provider Engagement Program through the Local Market Network Provider Representatives, creating a sustainable leadership structure. In doing so, I significantly improved our network by managing and directing both internal and external Network Provider Relations staff, setting a new standard for our Provider Relationships. In addition to these achievements, I was involved in the recruitment of new providers, ensuring our network always met all access requirements. My influence extended to developing and recommending comprehensive training programs and educational materials for our providers. •Focused on enhancing population health outcomes, my role expanded to developing and administering a diverse portfolio of improvement projects, targeting health equity and addressing Social Determinants of Health. I collaborated closely with internal teams and the governing bodies. Show less



Johns Hopkins Home Care

• Wellness and Fitness Services
• 1 - 100 Employee

• Payor Relations and Contracting Liaison

  • Nov 2016 - Feb 2017

  Baltimore, Maryland Area Leveraging my proficiency in managing administrative tasks, I have effectively supported the growth and execution of managed care contracts. My roles in this capacity encompassed comprehensive responsibilities such as credentialing, conducting fee schedule analyses, maintaining payer reference materials, and the development of strategic tools and communication channels to aid frontline staff. This hands-on experience has been instrumental in amplifying my understanding of managed care contracts… Show more Leveraging my proficiency in managing administrative tasks, I have effectively supported the growth and execution of managed care contracts. My roles in this capacity encompassed comprehensive responsibilities such as credentialing, conducting fee schedule analyses, maintaining payer reference materials, and the development of strategic tools and communication channels to aid frontline staff. This hands-on experience has been instrumental in amplifying my understanding of managed care contracts and their functional domains. Recognizing the importance of robust and continual communication, I ensured regular and open dialogue with insurance payers. I took the lead in resolving escalated concerns related to operational and reimbursement matters that remained unresolved for an extended period. My proactive approach was pivotal in quickly addressing a wide range of issues and thereby expedited solutions. My distinct ability to assert the organization's needs firmly and effectively, coupled with my talent for negotiating and resolving complicated matters, has consistently brought about swift and favorable resolutions. Overall, these experiences have honed my capabilities in the business standards environment, providing me with a well-rounded skillset and proven track record in managing complex managed care contracts and insurance payer communication. • Administered a portfolio of managed care contracts, resulting in improved operational efficiency and contract compliance. • Performed credentialing, fee schedule analysis, and maintenance of payer reference materials, boosting contract management proficiency by 20%. • Developed and implemented communication tools to support frontline staff in navigating managed care contracts, improving contract understanding and adherence. • Engaged in persistent negotiation with insurance payers, swiftly resolving escalated operational and reimbursement concerns to enhance service delivery and revenue cycle. Show less



CommuniCare Health Services

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Regional Managed Care Specialist

  • 2014 - 2016

  Lithicum Heights, MD As a key leader in the managed care sector, I've demonstrated exceptional abilities in the management and swift resolution of process-related challenges. My core strength lies in fostering and maintaining strategic relationships with third-party payers, collaboratively working towards enhancing patient accessibility to necessary treatments and ensuring their continuity of care as clinically warranted. In my tenure at Communicare, I effectively leveraged these alliances to secure optimal… Show more As a key leader in the managed care sector, I've demonstrated exceptional abilities in the management and swift resolution of process-related challenges. My core strength lies in fostering and maintaining strategic relationships with third-party payers, collaboratively working towards enhancing patient accessibility to necessary treatments and ensuring their continuity of care as clinically warranted. In my tenure at Communicare, I effectively leveraged these alliances to secure optimal reimbursement for services, thereby positioning Communicare as a preferred provider choice within the payer community. My role also involved educating various stakeholders, including patients, their families, referral sources, and internal team members on the intricacies of managed care, ensuring a comprehensive understanding of documentation and medical necessity criteria. A significant part of my responsibilities included pioneering, cultivating, and maintaining open lines of communication with referents, which fostered personalized, high-quality relationships. This allowed for complete engagement and active participation throughout the recovery services process. Additionally, my expertise extended to providing case management during the intake process whenever necessary, which further streamlined patient care and enhanced the service delivery system. Show less



Lorien Health Systems

• United States
• Hospitals and Health Care

• Managed Care Coordinator

  • Oct 2010 - 2013

  Ellicott City, MD With a significant focus on managed care contract negotiations and portfolio analysis, I have consistently supported organizational decision-making processes through in-depth analysis, comprehensive business research, and performance reporting. My expertise extends to detailed facility reimbursement analyses, through which I compare expected vs. actual returns under Managed Care agreements, identify underpayments, and monitor payer trends. In tackling contractual language issues, I have been… Show more With a significant focus on managed care contract negotiations and portfolio analysis, I have consistently supported organizational decision-making processes through in-depth analysis, comprehensive business research, and performance reporting. My expertise extends to detailed facility reimbursement analyses, through which I compare expected vs. actual returns under Managed Care agreements, identify underpayments, and monitor payer trends. In tackling contractual language issues, I have been instrumental in pursuing collections for underpaid claims, aligning my efforts with established policies and procedures while ensuring accuracy, timeliness, and professionalism. • Keen detail in reviewing Managed Care contracts and negotiating contract rate and language proposals effectively. • Responsible for the development and distribution of regular reports that detail identified underpayments, their reasons, and the amounts successfully collected. Recognizing the need for effective communication, I escalate issues to Provider Representatives and other relevant parties when required. Show less



RadNet

• Greece
• Book and Periodical Publishing
• 1 - 100 Employee

• A/R Coordinator

  • Jun 2009 - Oct 2010

  Rockville, MD Provided various support services, inclng, but not limited to generating and monitoring accounts receivables in computerized accounts receivable and billing program, coding cash receipts in cash receipts journal and printing monthly cash receipts journals, processing collections, computing average collection periods, and coordinated related service needs. Provided the development of fiscal support systems and services for the organization and maintained organized claim filing systems, to comply… Show more Provided various support services, inclng, but not limited to generating and monitoring accounts receivables in computerized accounts receivable and billing program, coding cash receipts in cash receipts journal and printing monthly cash receipts journals, processing collections, computing average collection periods, and coordinated related service needs. Provided the development of fiscal support systems and services for the organization and maintained organized claim filing systems, to comply with company policies and governmental regulations. Coordinated and supervised various assignments, as delegated by Regional Office management, Corporate Accounting, and Operations. • Handled day-to-day intricacies involved in overseeing account receivable reports and resolving all matters that would impact reimbursement we receive for all submitted claims. • Developed free form administrative appeals and letters of medical necessity, while maintaining an above average knowledge of the healthcare industry. • Maintained consistent interaction with the clinical community and aid in the resolution to complex issues, simultaneously researching related issues, solely or collaboratively to reach resolution. • Analyzed billing and coding edits for trending discrepancies to prevent claim payment delays. • Ensured authorizations were obtained efficiently, while maintaining compliance with timely filing guidelines and HIPPA compliance. • Properly managed the reconciliation of all insurance payments, to ensure success during end of month processes. • Maintained a understanding of hospital billing and collections, with a working knowledge of physician professional fee billing and collections practices. • Researched denials and sought adjudication based on contractual agreement. • Provided administrative support to management team as needed to ensure seamless department operations. • Maintained reports and request to aid toward the retention of statistical data. Show less



Wells Fargo

• United States
• Financial Services
• 700 & Above Employee

• Banker

  • 2008 - 2008

  Santa Monica, California



HSBC

• United Kingdom
• Financial Services
• 700 & Above Employee

• Banker

  • 2007 - 2008

  Assisted in managing operational and customer service activities within a branch, ensuring compliance with established internal operational standards and government regulations. Assisted in managing, leads, coaches and participates in sales activities to develop and expand customer relationships. Complete accounting- related responsibilities including regular cash control activities (ATM processing, current transaction system reconciliations, negotiable instruments) and general ledger account… Show more Assisted in managing operational and customer service activities within a branch, ensuring compliance with established internal operational standards and government regulations. Assisted in managing, leads, coaches and participates in sales activities to develop and expand customer relationships. Complete accounting- related responsibilities including regular cash control activities (ATM processing, current transaction system reconciliations, negotiable instruments) and general ledger account maintenance and reconciliation. Ensured the overall appearance of the branch is appropriate and proper stocking and placement of collateral. Created and maintained an appropriate level of focus, operational integrity, and control within the financial center. Developed and follow through on action plans to improve operational controls, mitigate losses and ensure consistent and superior client experience. Assisted in leading and managing tellers to maximize referral opportunities, establish and maintain clear, consistent leadership and communication process to financial center on all control matters. • Resolved difficult customer situations effectively while delivering friendly customer service and ensuring the highest level of customer satisfaction. • In depth comprehensive knowledge of branch functions and operations. • Strong relationship building, by ensuring excellent customer service was given to clients. • Monitored reports based on balanced fluctuation • Ensured rules and guidelines established by Human Resources were adhered to. • Maintained adequate records of staffs personnel files for the review of senior management. •Acquired and maintained a successful household deposit base. • Identified potential quality gaps and process improvements to ensure achievement of branch performance targets. • Ensure timely, accurate, and courteous customer service for ease of swift resolutions during the handling of complex customer matters. Show less



Citigroup

• United States
• Financial Services
• 700 & Above Employee

• Banking Officer

  • 2006 - 2008

  As a Service Officer (Platform Supervisor), I worked closely as an assistant to the Financial Center and Financial Center Operational Manager. Deepened the understanding of each clients current financial position and needs, leveraging services tailored to meet their expectations. Created and maintained appropriate levels of focus, operational integrity, and control within the Financial Center. Developed and followed through on action plans to improve operational controls, mitigate losses and… Show more As a Service Officer (Platform Supervisor), I worked closely as an assistant to the Financial Center and Financial Center Operational Manager. Deepened the understanding of each clients current financial position and needs, leveraging services tailored to meet their expectations. Created and maintained appropriate levels of focus, operational integrity, and control within the Financial Center. Developed and followed through on action plans to improve operational controls, mitigate losses and ensure consistent and superior client experiences. Built long-term relationships with customers in person, and by phone; this assisted an effort of leading and managing tellers to maximize referral opportunities, establish and maintain clear, consistent leadership and communication process to Financial Center on all control matters. Monitored quality and timeliness of services delivered to clients, to maximizes sales, in addition to meeting and exceeding requirements to guarantee the client satisfaction. - Proven track record in loss reduction, and risk management - Ability to analyze and improve process - Demonstrated sales coaching - In depth comprehensive knowledge of branch functions and operations. - Strong relationship building - Excellent customer service skills - Monitored reports based on balanced fluctuation - Processed and analyzed processed wires - Best service performance in the Mid-Atlantic Region - Acquired and maintained a successful household deposit base. - Exceeded challenging sales and referral goals by proactively selling products and services to customers and referring customers to other areas of the bank. - Developed and maintained relationships with Citi-bank partners to maximize sales opportunities Show less



Capital One

• Egypt
• Leasing Non-residential Real Estate

• Financial Associate

  • Oct 2005 - Jun 2006

  Laurel, MD Utilizing the companies vision, while remaining in compliance with various regulations and Federal Reserve guidelines, I worked vigously to serve customers total financial service by focus on their complete financial standing in order to cross sales banking products by way of "need based selling", which ultimately resulted in greater market share for our branch. Assessing and meeting the needs of our clients, was a vital expectation that fell within the scope of my responsibilities, by solving… Show more Utilizing the companies vision, while remaining in compliance with various regulations and Federal Reserve guidelines, I worked vigously to serve customers total financial service by focus on their complete financial standing in order to cross sales banking products by way of "need based selling", which ultimately resulted in greater market share for our branch. Assessing and meeting the needs of our clients, was a vital expectation that fell within the scope of my responsibilities, by solving customer problems to satisfy their financial. Providing financial educations and managing their non-security financials to reinforce the objective of establishing and maintaining financial security; my goal was to ensure that my clients succeeded financially, paving the opportunity well vested client relationships with the bank. Utilizing various segment leaders and counterparts who specialized in Business Banking; Mortgage Products; licenses Wealth Management professional and other areas of expertise, enabled me to strengthen relationships with executive teams by apprising them of financial reports; relevant accounting and financial data relative to our branches increasing monetary growth to maintain our top tier financial center status within our district. Illustration our consistent ability to exceed our monetary deposit base threshold was accomplished by not only achieved by adhering to the principles set by the company, it was also necessary to use "non- cookie cutter" approaches to solve the needs of you clients. Operationally speaking, I was involved in overseeing financial statements and assisting with internal mock audits and impromptu federal audits, which were customary practices. Show less



Social Security Administration

• Government Administration
• 700 & Above Employee

• Student Intern - Human Resources

  • Jun 2005 - Oct 2005

  Woodlawn, MD