Experience

Devoted Health

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

• Provider Network Manager

  • May 2022 - Present



Aetna, a CVS Health Company

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

• Network Relations Manager - Remote

  • Mar 2017 - May 2022

  Responsible for physician group contracting, network expansion, network adequacy, provider data integrity, and relationship management for the Memphis, TN metro region (1.3 million residential footprint) and Western Upstate New York (1.2 million residential footprint) Establish and maintain strong, positive relationships with providers to leverage for business development initiatives Recruit targeted providers by developing and executing negotiation strategies that adhere to unit cost… Show more Responsible for physician group contracting, network expansion, network adequacy, provider data integrity, and relationship management for the Memphis, TN metro region (1.3 million residential footprint) and Western Upstate New York (1.2 million residential footprint) Establish and maintain strong, positive relationships with providers to leverage for business development initiatives Recruit targeted providers by developing and executing negotiation strategies that adhere to unit cost targets and access standards Ensure successful end-to-end contracting for Commercial and Medicare network providers Act as a liaison between providers and internal payer stakeholders (ex. Claims, Appeals, Policy, and Legal) to resolve provider issues Evaluate network operations and reporting to identify risks, satisfy network adequacy standards, and act on territory expansion opportunities

• Plan Sponsor Liaison

  • Oct 2013 - Mar 2017

  Participated in multi-product plan sales meetings and prospect calls to retain existing business, up-sell existing cases, and attract new plan sponsors. Acted as the project lead for transition business in and out of service center, including product installation by participating in implementation planning/process meetings. Developed and executed a customer service account management plan for assigned cases. Served as the single point of contact for the human resources director and… Show more Participated in multi-product plan sales meetings and prospect calls to retain existing business, up-sell existing cases, and attract new plan sponsors. Acted as the project lead for transition business in and out of service center, including product installation by participating in implementation planning/process meetings. Developed and executed a customer service account management plan for assigned cases. Served as the single point of contact for the human resources director and management team (benefit coordinator, administrator, etc.) for Aetna Medical plan sponsor clients: Baptist Memorial Health Care Corporation, Maury Regional Medical Center, Marshall Medical Center, Williamson Medical Center, NorthCrest Medical Center, Bechtel Global Corporation, and Freddie Mac. Proactively identified and executed resolution strategies for customer and plan issues while acting as a liaison to communicate workflow results, ideas and solutions to key stakeholders (account executives, sales representatives, installation managers and the claims office as appropriate).

• Health Concierge

  • Jan 2010 - Oct 2013

  Provided targeted, personalized service based on a holistic view. Acted as the customer’s single-point-of-contact to address service inquiries and escalations for Medical, Dental, Vision, Life, and Supplemental products and escalations via telephone, e-mail, and web chat. Engaged, consulted, and educated each customer by assessing each to ensure their unique needs and preferences were met. Took ownership to resolve customer issues with limited management intervention.

• Customer Service Representative

  • Jul 2007 - Jan 2010

  Handled Medical plan customer service inquiries and problems via telephone while maintaining accuracy and production standards Documented and tracked contacts with plan members Performed review of plan member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible