Experience

Humana Behavioral Health

• United States
• Hospital & Health Care
• 1 - 100 Employee

• Large Practice and Ancillary Contracting Executive

  • Mar 2007 - Present

  •Analyze reports to strategize for recruitment •Contract with practitioners, large groups and facilities for Letter of Agreements (LOA’s) and long term contracts•Develop professional relationships with practitioners •Travel for network recruitment•Identify preferred providers in geographic regions under development •Negotiate rates and contract language for network and out of network practitioners•Solicit out of network providers for in network participation•Assist with special projects, as requested•Write Narratives prior to submission to HSD Tables for CMS filing

• Team Lead of Provider Relations & Level 1 Contractors

  • Mar 2007 - Feb 2009

  •Supervised 13 employees•Created, edited and maintained policy and procedures•Traveled for network recruitment•Approved negotiations for new provider contracts including Commercial and Medicare•Overseen the preparation of credentialing documents for submission to the credentialing department•Responsible for running weekly Flash Reports•Built and maintained relationships with providers•Researched and resolved complex claims issues related to provider contracts•Acted as a liaison between multiple departments to ensure clients’ needs are met while maintaining provider satisfaction•Analyzed reports to strategize for recruitment •Trained new hires•Scheduled Provider Forums by sending out invitations along with registration forms, negotiate rates with hotels and assist in scheduling flights•Overseen the preparation of Narratives prior to the submission of HSD Tables for CMS filing.



Clinical Nephrology Associates

• Fort Worth, TX

• Medical Billing

  • Oct 2006 - Mar 2007

  •Verified insurance •Assisted front office receptionist •Scheduled appointments •Scanned documents •Medical billing •Pre-certed patient care •Prepared and combined patient files in a new database system: EMR •CPT and ICD 9 Coding •Filing •Answering phones •Verified insurance •Assisted front office receptionist •Scheduled appointments •Scanned documents •Medical billing •Pre-certed patient care •Prepared and combined patient files in a new database system: EMR •CPT and ICD 9 Coding •Filing •Answering phones



Humana Behavioral Health

• United States
• Hospital & Health Care
• 1 - 100 Employee

• Provider Relations Representative - Provider Development Specialist - Quality Improvement Specialist

  • Jul 2000 - Aug 2006

  •Assisted in achieving NCQA (National Committee for Quality Assurance) accreditation for Corphealth •Ensure that practitioners meet Corphealth’s standards for treatment records, clinical practice guidelines and coordination of care; including scheduling the on-site audits, collecting and analyzing data and presenting results to internal and external committees •Create, edit and maintain policy and procedures •Contracted with practitioners and facilities for Letter of Agreements (LOA’s) and long term contracts •Developed professional relationships with in-network practitioners and assist in addressing areas of concern •Identified and developed network in areas of deficiency and new business •Negotiated rates for network practitioners •Assisted in training of new employees in Provider Relations •Cross-trained in all areas of Provider Relations and Customer Service •Performed contract language changes