Experience

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  Universal Hospital Services

  • Regional Director, Managed Care And Payer Strategies

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  UHS

  • Regional Director, Managed Care and Payer Strategies

    • Jan 2020 - Present

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  Adventist HealthCare

  • Gaithersburg, Maryland

  • Managed Care Finance Manager

    • Oct 2015 - Dec 2019
    • Gaithersburg, Maryland

    Review and negotiate contracts on behalf of Adventist Healthcare for acute care hospitals, behavioral health services, home health, rehabilitation services, and urgent care. Conduct data analytics on rate proposals for the One Health Quality Alliance Clinically Integrated Network (CIN). Perform contract audits to determine payer compliance with negotiated and HSCRC rates. Resolve payment inaccuracies with payers when necessary. Lead Managed Care Department DMAIC initiatives.

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  Amerigroup

  • Hanover, MD

  • Manager, Provider Network Operations

    • Apr 2013 - Aug 2015
    • Hanover, MD

    Managed the provider network for the largest Medicaid MCO in Maryland to meet COMAR required provider types and members access standards. Worked with multiple internal departments to resolve provider complaints and claims problems, facilitate provider credentialing, and link members to in-network providers. Negotiated contracts with new providers and supervised provider representatives.

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  Ameritox

  • 300 E. Lombard St. Baltimore, MD 21202

  • Compliance Program Director

    • Oct 2012 - Feb 2013
    • 300 E. Lombard St. Baltimore, MD 21202

    Responsible for managing and monitoring compliance systems to assure that Company operations are consistent with compliance requirements, and assisting in the development of comprehensive policies and procedures, compliance training, protocols, internal investigations, ensure integrity and compliance of focus arrangements, and overall compliance culture of the corporation.

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  UnitedHealth Group

  • Compliance Consultant

    • 2006 - 2012

    Coordinated the market conduct exam from inception through completion. Worked with internal partners to provide mandated data to external regulators in a timely and accurate manner and mitigate issues as they arose. Developed corrective action plans to address findings of the exam and partnered with impacted departments to implement the plan. Conducted internal assessments to validate corrective action plan effectiveness. In addition, I coordinated the internal self monitoring reporting initiative for Dental, Vision, Mental Health, and Care Solutions lines of business and served as subject matter expert for Dental and Vision lines of business.

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  Upper Chesapeake Health System

  • Manager, Managed Care and Compliance Audit

    • 1999 - 2006

    Developed annual audit work plan, coordinated audits and reported results to the Compliance Council. Examined processes and implemented internal controls to ensure legal compliance. Negotiated regulated and unregulated contracts with insurers, developed and maintained positive relationships with insurers, and audited facility reimbursement for contract compliance.