Experience

Devoted Health

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

• Provider Network Manager

  • Aug 2022 - Present



Medical Solutions Supplier

• United States
• Medical Equipment Manufacturing
• 1 - 100 Employee

• Market Access & Payer Relations Manager

  • Feb 2023 - Present



Complete Health

• United States
• Medical Practices
• 100 - 200 Employee

• Payer Relations, Network and Contracting Manager

  • Jul 2021 - May 2023



Conviva Physician Group

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Contracting Executive, Shared Services, CONVIVA CARE SOLUTIONS

  • Jan 2018 - Jul 2021

  -Assisted Market leadership with profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of contracted IPA Primary Care offices with approximately 13,000 members. -Actively participated in leadership meetings and demonstrated awareness of market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. -Established practices, policies and procedures to ensure… Show more -Assisted Market leadership with profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of contracted IPA Primary Care offices with approximately 13,000 members. -Actively participated in leadership meetings and demonstrated awareness of market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. -Established practices, policies and procedures to ensure alignment to objectives by communicating effectively across all levels of the organization with the appropriate message, the right tone and the appropriate level of impact. Show less -Assisted Market leadership with profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of contracted IPA Primary Care offices with approximately 13,000 members. -Actively participated in leadership meetings and demonstrated awareness of market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. -Established practices, policies and procedures to ensure… Show more -Assisted Market leadership with profit and loss (P&L) account responsibility for a Medicare Managed Service Organization consisting of contracted IPA Primary Care offices with approximately 13,000 members. -Actively participated in leadership meetings and demonstrated awareness of market’s operational and strategic priorities, while providing advisement on strategies and processes to enhance systems and key initiatives. -Established practices, policies and procedures to ensure alignment to objectives by communicating effectively across all levels of the organization with the appropriate message, the right tone and the appropriate level of impact. Show less



MCCI Group Holdings, LLC

• United States
• Medical Practices

• Market Leader

  • Dec 2015 - Jul 2021

  -Increased satisfaction score by 5% in Primary Care offices across 6 Medicare Markets, while maintaining a quality (HEDIS / STARs) score in affiliate offices to 4.55, an overall score of 4.35, and a 30-day readmission rate of < 16%. -Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. -Utilized industry-based… Show more -Increased satisfaction score by 5% in Primary Care offices across 6 Medicare Markets, while maintaining a quality (HEDIS / STARs) score in affiliate offices to 4.55, an overall score of 4.35, and a 30-day readmission rate of < 16%. -Collaborated effectively with internal and joint venture partners to make decisions that impact the whole of the organization and make decisions using broad knowledge of the organization’s long- term vision, values, and strategy. -Utilized industry-based knowledge and perspective to translate strategies into actions by encouraging internal and joint venture partners to embrace and advance the enterprise strategy in existing and developing markets. ·Strategically developed partnerships across the enterprise to align resources and enhance systems that further improved utilization performance by decreasing hospital admissions in multiple Medicare Markets.

• Provider Relations Manager, MCCI Group Holdings LLC

  • Jan 2013 - Nov 2015

  ·Led operations, creation, and execution of network strategy for Atlanta Market, serving 40K Medicare members, in collaboration with Finance, Humana Market Point Sales and Health Services and developed budget for those Markets. ·Developed relationships with Medicare Sales Directors and Brokers in the Metro Atlanta area to determine contracting initiatives while meeting membership growth targets of approx. 5% regionally. ·Exceeded market objectives for Medicare Membership growth… Show more ·Led operations, creation, and execution of network strategy for Atlanta Market, serving 40K Medicare members, in collaboration with Finance, Humana Market Point Sales and Health Services and developed budget for those Markets. ·Developed relationships with Medicare Sales Directors and Brokers in the Metro Atlanta area to determine contracting initiatives while meeting membership growth targets of approx. 5% regionally. ·Exceeded market objectives for Medicare Membership growth, retainable disenrollment, HEDIS / STARs and Medical Expense Ratio

• Sr. Provider Relations Representative

  • Oct 2011 - Dec 2012

  ·Developed and managed Medicare Advantage HMO Primary Care and Specialty Physician networks in various Florida counties, that included contracting, auditing and maintaining contracts and relationships. ·Initiated, established, and expanded a provider network and completed Centers for Medicare and Medicaid Services (CMS) filing for Medicare Advantage HMO in five Florida counties for the Jacksonville Market.



CIGNA Healthcare Inc

• North Florida and Panhandle

• Provider Relations Representative

  • Nov 2009 - Oct 2011

  -Managed the primary care, specialist, hospital based physicians, ancillary and hospital network for the North Florida region. -Coordinating and conducting physician to physician peer reviews for clinical and financial alignment with the intent of the hospital contract reporting out directly to upper management. -Review physician network for geo access to ensure compliant with CMS standards. -Managed the primary care, specialist, hospital based physicians, ancillary and hospital network for the North Florida region. -Coordinating and conducting physician to physician peer reviews for clinical and financial alignment with the intent of the hospital contract reporting out directly to upper management. -Review physician network for geo access to ensure compliant with CMS standards.



Humana

• United States
• Insurance
• 700 & Above Employee

• Large Practice and Ancillary Contractor

  • May 2008 - Nov 2009

  -Served as liaison for Risk Arrangement/Managed Service Organizations (MSOs) affiliated with Humana: Physician Partners of Greater Orlando and Associates (PPGO) and Health Excel that span of North and Central Florida. -Use analytical skills to assess the physician network for potential cost-savings, identify key physician partners in primary and specialty networks. -Establish a professional working relationship with internal and external partners. Successfully negotiate and execute… Show more -Served as liaison for Risk Arrangement/Managed Service Organizations (MSOs) affiliated with Humana: Physician Partners of Greater Orlando and Associates (PPGO) and Health Excel that span of North and Central Florida. -Use analytical skills to assess the physician network for potential cost-savings, identify key physician partners in primary and specialty networks. -Establish a professional working relationship with internal and external partners. Successfully negotiate and execute PCP, specialty and ancillary agreements to completion.

• Physician Contractor

  • Nov 2007 - May 2008

  -Physician recruitment, contracting (LOAs and MOAs), re-negotiating and servicing agreements on Humana's behalf. -Jacksonville, Daytona and Greater Orlando area for various specialties.



WellCare Health Plans

• United States
• Insurance
• 700 & Above Employee

• Physician Contractor

  • Nov 2005 - Nov 2007

  -Network assessment, recruitment of specialists and primary care physicians for the Medicaid and Medicare lines of business: Staywell, Healthease and Wellcare products offered in the state of Florida. -Inspections to ensure practices met Florida regulations and requirements for providing care to pediatric, indigent, elderly and disabled member as well as meeting OSHA, Medicaid and Medicare specific requirements related to credentialing, etc. -Network assessment, recruitment of specialists and primary care physicians for the Medicaid and Medicare lines of business: Staywell, Healthease and Wellcare products offered in the state of Florida. -Inspections to ensure practices met Florida regulations and requirements for providing care to pediatric, indigent, elderly and disabled member as well as meeting OSHA, Medicaid and Medicare specific requirements related to credentialing, etc.



Blue Cross and Blue Shield of Florida

• Provider Relations Representative

  • May 2004 - Nov 2005

  -Managed high tier physician practices and ancillary providers, ensuring that the intent of the agreement was fulfilled, auditing and maintenance of the contract was complete able to be administered by the plan. -Determined root cause and problem resolution as the primary point of contact between the physician/provider and the health plan.

• Provider Relations Representative

  • Feb 2003 - May 2004

• Provider Relations Support Representative

  • Aug 2001 - Jan 2003

  -Supported provider relations team as an extension of services to the provider network in the North Florida area. -Responsible for claims projects, adhoc reporting to assist in claims reconciliation, including overpayment and recovery, audit networks for deficiencies and recruit physicians as needed, and assist with the credentialing process.

• Blue Card InterPlan Representative

  • Jun 1999 - Jan 2003

• Customer Service Representative

  • Oct 1997 - Jun 1999