Experience

Devoted Health

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

• Provider Network Manager

  • Jul 2020 - Present



Aflac

• United States
• Insurance
• 700 & Above Employee

• Benefits Consultant

  • Jun 2019 - Present

  Cleveland/Akron, Ohio Area



United States Army Reserve

• United States
• Armed Forces
• 700 & Above Employee

• Operations - Military Police Officer

  • Jan 1999 - Present

  North Canton, OH Military Police Officer – Platoon Sergeant • Managed a platoon of 50 military police soldiers; emphasizing career development. • Performed and directed military police duties to include law and order, and internment resettlement during combat. • Responsible for the welfare of soldiers in my command during non-hostile and hostile situations. • Completed Equal Opportunity Representative, Duty Appointed Retention NCO, and Small Group Leader’s course. • Developed various leadership… Show more Military Police Officer – Platoon Sergeant • Managed a platoon of 50 military police soldiers; emphasizing career development. • Performed and directed military police duties to include law and order, and internment resettlement during combat. • Responsible for the welfare of soldiers in my command during non-hostile and hostile situations. • Completed Equal Opportunity Representative, Duty Appointed Retention NCO, and Small Group Leader’s course. • Developed various leadership skills by attending leadership courses such as Warrior Leadership course, Advanced Leadership course, and Senior Leadership course. Show less



Medical Mutual

• United States
• Insurance
• 700 & Above Employee

• Senior Provider Contracting Representative

  • Jan 2008 - May 2019

  Cleveland/Akron, Ohio Area • Senior Contracting Provider Representative • Negotiate various contracts with medical care providers and hospital facilities in and out of Medical Mutual’s network of providers to include Medicare Advantage and quality of care for members. • Negotiate contracts with medical care providers and hospital facilities for the Medicare Advantage • Analyzed financial documents for cost savings within the negotiated contracts. • Act as a team leader by providing coaching and mentoring… Show more • Senior Contracting Provider Representative • Negotiate various contracts with medical care providers and hospital facilities in and out of Medical Mutual’s network of providers to include Medicare Advantage and quality of care for members. • Negotiate contracts with medical care providers and hospital facilities for the Medicare Advantage • Analyzed financial documents for cost savings within the negotiated contracts. • Act as a team leader by providing coaching and mentoring to other contracting representatives as well as the coordinators. • Provide Provider Service and Education by field visits and attending seminars. • Create and implement standards of operating procedures manual for the contracting department. • Recruit medical provider services to join new network products with Medical Mutual. • Analyze the health insurance industry market in order to remain competitive within the market. Provider Contracting Coordinator • Reviewed, analyzed, and investigated claims payment against provider contracts. • Assisted with daily administrative tasks to include scheduling of training and meetings with current and potential clients. • Improved communication efficiency as primary liaison between departments, clients and vendors. Consistently praised by management for the quality and timeliness of reports, attention to detail, exemplary customer service delivery and team-player attitude. • Prepared power point presentations and training material as a team member of the CP8 Claims Routing Committee and the Goldmine System Committee.

• Provider Contracting Coordinator

  • Apr 2008 - Jan 2012

  Cleveland/Akron, Ohio Area • Bilingual Customer Service Representative • Bilingual (Spanish) company representative for providing health insurance benefits and processing of medical claims. • Participated as a member of the Misquote Committee in developing strategies in providing better customer service. • Researched and composed cost effective measures. • Organized and developed training strategies and training aids to assist representatives in provided accurate information.