Experience

Alinea Medical Imaging - a Rezolut partner

• United States
• Medical Practices
• 1 - 100 Employee

• Sr. Provider Relations & Contracting Manager

  • Jan 2020 - Present

• Contracting & Provider Relations Manager

  • Aug 2017 - Jan 2020

  Mobile Mammograms Throughout California*Mobile Breast Cancer Screening*6-8 Patients Every Hour*Improve HEDIS scores 20%-80%*2 Self Contained Coaches*4 Mobile Mammography units*2 standing locations in Pomona and Santa Ana



Imperial Health Plan of California

• United States
• Insurance
• 1 - 100 Employee

• Contact Manager

  • Jun 2016 - Jun 2017

  • Manage and Contract network for Imperial Health Plan of California (IHPC) *Ancillary (Skilled Nursing Facilities, Home Health, Ambulatory Surgery Centers), Hospitals, Sub IPA, Health Plans • Manage and Contract network for Imperial Health Holdings Medical Group (IHHMG) *PCPs, Specialist, Laboratories, Diagnostic facilities, Ancillary • Manage Sub IPA network • Manage Health Plan DOFRs • Manage network within Health Axis system • Load Health Plan benefits in Health Axis • Load DOFRs to Health Axis • Load all contracts in Health Axis • Travel through California for Business Development with Plan Partners • Health Plan submission for new business • Marketing development Show less



Preferred IPA of California

• United States
• Medical Practices
• 1 - 100 Employee

• Provider Relations

  • May 2013 - Jun 2016

  Knowledgeable with ACO, Health Plan and IPA contracts, Medi-Cal, Healthy Families, Commercial, Medicare, and Child Health and Disability Prevention Program, Medical terminology, Completing CPPA applications • Develop and manage, PCP, hospital, specialty, and ancillary networks. Negotiations for PCP and Specialty contracts. Handling claim issue resolution, provider adds, changes and terms, hospital, and provider group JOCs. • Accountable Care Organization (ACO) Project Manager – Manage our ACO network of providers, trainings, updates, audits, and marketing. Work with our management team to develop care coordination strategies. Setup protocols for the network, provider training, and internal implementation Show less



Care 1st Health Plan

• United States
• Insurance
• 1 - 100 Employee

• Provider Network Administrator

  • Nov 2008 - Jan 2013

  • Network Administrator for 17 IPA’s, Division of Financial Responsibility (DOFR) Interpretation, Department Managed Health Care filings, claim issue resolution, provider adds, changes and terms, quarterly roster validations, coordinating Joint Operation Meetings, liaison between the IPA and health plan, policy and procedure updates and changes, provider visits, and daily inbound and outbound provider call administration. • Network Administrator for 17 IPA’s, Division of Financial Responsibility (DOFR) Interpretation, Department Managed Health Care filings, claim issue resolution, provider adds, changes and terms, quarterly roster validations, coordinating Joint Operation Meetings, liaison between the IPA and health plan, policy and procedure updates and changes, provider visits, and daily inbound and outbound provider call administration.



L.A. Care Health Plan

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

• Provider Relations Representative

  • Nov 2007 - Nov 2008

  • Provider adds, changes and terms, IPA term crossovers, Open authorization reports, Customer Service/Managed Care 101 trainings, organizing Joint Operation Meeting with IPA’s, liaison between the IPA and health plan, handling inbound and outbound provider calls, creating policies and procedures, provider visits • Provider adds, changes and terms, IPA term crossovers, Open authorization reports, Customer Service/Managed Care 101 trainings, organizing Joint Operation Meeting with IPA’s, liaison between the IPA and health plan, handling inbound and outbound provider calls, creating policies and procedures, provider visits



Northeast Community Clinic

• Hospitals and Health Care
• 1 - 100 Employee

• Managed Care Coordinator

  • Sep 2005 - Nov 2007

  • Processed Initial and re-credentialing for all providers, contracting, liaison between clinic and IPA’s, IPA reimbursement, IPA membership, marketing, CAA enrollment processing, processed National Provider Identifiers for all providers and clinic sites. • Processed Initial and re-credentialing for all providers, contracting, liaison between clinic and IPA’s, IPA reimbursement, IPA membership, marketing, CAA enrollment processing, processed National Provider Identifiers for all providers and clinic sites.



Network Medical Management

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Provider Relations Representative

  • Dec 2003 - Jun 2005

  • Network Representative for 6 IPA’s, PCP and Specialty provider visits, coordinated and hosted IPA provider meetings, handling claim issue resolution, provider adds, changes and terms, resolved provider issues, and updated provider manual. • Network Representative for 6 IPA’s, PCP and Specialty provider visits, coordinated and hosted IPA provider meetings, handling claim issue resolution, provider adds, changes and terms, resolved provider issues, and updated provider manual.