Experience

EWINGS INC.

• United States
• Insurance
• 1 - 100 Employee

• Veteran Affairs Network Contractor

  • May 2019 - Present

  •Responsible for building a VA Community Care Network (VACCN) for Region 3 providers (responsible for Alabama, Georgia, and South Carolina) . •Developed provider network consisting of hospitals, ancillary groups/facilities, and physicians. •Negotiated new and existing contracts for VACCN providers •Evaluated and negotiated single case agreements and contracts in compliance with correct templates and reimbursement structure standards. •Drafted new contracts and amended existing contracts via Emptoris and/or CLM (Contract Lifecycle Management). •Educated providers on the VACCN program and provided explanations and information on difficult issues with VACCN contracting status via NDB (Network Database) . •Documented contracting progress in VA Contracting Tool •Provided coaching, feedback, and guidance to colleagues as needed. Show less



Glenridge Health

• United States

• Managed Care Consultant

  • Nov 2013 - Apr 2019

  •Responsible for negotiating contract rates for professional, ancillary and facility providers including Rural Health Clinics and Federally Qualified Health Clinics •Responsible for identifying providers to meet network adequacy for a market •Recruiting dental providers for Liberty Dental Medicare Advantage Plan for Ohio and Wisconsin •Recruiting providers for Humana/Texas STAR Plus, STAR and CHIP Programs. •Recruiting providers for Anthem/Amerigroup for a Medicare Advantage plan in Mississippi, Louisiana, Alabama, Tennessee, and Arkansas. •Recruiting providers for Ambetter Health/Centene Marketplace health plan •Recruiting provider for a Medicare Advantage Plan for Cigna Health Spring (Maryland, Delaware and DC markets) •Recruiting provider for Medicare Cost Plan for Medica in the Kansas market •Establishing a viable Medicare Assured and Medicaid network for Gateway Health Plan in Ohio, Kentucky, North Carolina, Michigan, New Jersey and Louisiana markets. •Recruiting providers for Beacon Health Strategies in New York and Georgia for a Medicaid managed care product for behavioral health, LTSS including 1915(i) services. Show less



OnPoint Partners

• United States
• Staffing and Recruiting
• 1 - 100 Employee

• Network Development Rep

  • May 2013 - Jan 2017

  •Responsible for promoting Cofinity Auto Network to physicians in Ohio, New York and Arizona •Responsible for provider demographic information updates •Responsible for negotiating contract rates for the Auto Network •Responsible for building a network to meet market needs •Responsible for converting Cofinity contracts into Aetna Workers’ Compensation contracts •Responsible for promoting Cofinity Auto Network to physicians in Ohio, New York and Arizona •Responsible for provider demographic information updates •Responsible for negotiating contract rates for the Auto Network •Responsible for building a network to meet market needs •Responsible for converting Cofinity contracts into Aetna Workers’ Compensation contracts



Advanced Solutions Consulting Group, Inc

• Business Consulting and Services

• Managed Care Contractor

  • Jun 2012 - Apr 2013

  •Responsible for promoting the Aetna Better Health Network to Georgia and Illinois professional, ancillary physicians •Responsible for provider demographic changes and providing Medicaid reimbursement rates •Responsible for sending a Letter of Intent, Contracts and Amendments to physicians during a network build for Medicaid or DUALS Network •Set targets to meet specific network adequacy •Responsible for promoting the Aetna Better Health Network to Georgia and Illinois professional, ancillary physicians •Responsible for provider demographic changes and providing Medicaid reimbursement rates •Responsible for sending a Letter of Intent, Contracts and Amendments to physicians during a network build for Medicaid or DUALS Network •Set targets to meet specific network adequacy



Humana

• United States
• Insurance
• 700 & Above Employee

• Sr. Provider Education Relations Rep

  • Jun 2005 - Jun 2007

  •Establishing and maintaining an appropriate and viable network of providers in the service area •Set targets and priorities to meet market specific network needs •Responsible for completing and negotiating physician contracts •Function as the single point of contact for contractual and service issues as needed by providers •Provide ongoing provider education and training to assist proper utilization and claims payment •Responsible for claims review and adjudication for Tricare Show less



Wellpoint Anthem

• Insurance
• 700 & Above Employee

• Network Services Rep

  • Aug 2001 - Jun 2005

  •Selling the advantages of joining the Medicare HMO network to physicians •Recruiting physicians who are existing customers on contract extensions/renewal after contract expires •Responsible for provider demographic changes and providing fee schedules per request •Responsible for managing contractual issues for PAR, HMO and PPO providers in five Georgia markets •Selling the advantages of joining the Medicare HMO network to physicians •Recruiting physicians who are existing customers on contract extensions/renewal after contract expires •Responsible for provider demographic changes and providing fee schedules per request •Responsible for managing contractual issues for PAR, HMO and PPO providers in five Georgia markets