Experience

AmeriHealth Caritas Florida

• Hospitals and Health Care
• 1 - 100 Employee

• Provider Network Account Executive II

  • Jan 2019 - Present

  Develops and maintains positive working relationships between the health plan and its contracted providers through an in depth understanding of the Plan’s contracts, and provider performance and needs. -Monitors and manages a significant network of PCPs and Specialists within Palm Beach County, working directly with those providers to maintain quality healthcare to enrollees and assuring appropriate access to services throughout assigned territory. -Identifies and actively solicits qualified providers to participate in Plan at new and existing service areas, ensuring that the financial integrity of the Plan is maintained, and contract management requirements are adhered to, including language, terms and reimbursement requirements. -Collaborates with Quality and Case Management, Grievance and Appeals, as well as Compliance to investigate, resolve, and mitigate potential quality issues. -Creates all processes and procedures for Provider Network Management by collaborating with leadership and division partners to ensure compliance with contractual requirements. -Manages and leads special projects to completion, as needed, in order to meet internal, contractual, and statutory requirements. Show less

• Risk Management Business Analyst

  • May 2017 - Jan 2019

  Maintains compliance with the statutory, contractual, and reporting requirements of the health plan while identifying and evaluating risks to reduce injury to members all the while working proactively and reactively to identify and mitigate to the organization and its members and associates. - Liaise between Quality Management and Delegation Oversight to streamline and oversee the Quality of Care reviews for cases involving health plan subcontractors, greatly reducing redundancy and increasing productivity. - Oversees Enrollee complaint process as it relates to Prestige subcontractors, works proactively with business partners and units to resolve process or system issues, as well as identified trends that have the potential to impact member quality of care. - Consistently meets deadlines of reporting Adverse and Critical Incidents to the Agency.- Instrumental in achieving 98% compliance with Annual Risk Management and Compliance Training in 2017. - Organized and created multiple educational presentations for internal departments which significantly minimized the number of inappropriate referrals received by the Risk and Quality Management departments. Show less



Assurant, Inc.

• United States

• Sr. Procurement Analyst

  • 2015 - 2017

  Single point of contact for suppliers, developing and maintaining effective relationships by implementing, managing and monitoring the governance process for non-outsourced commodity suppliers. - Instrumental in the achievement of the team goal to roll 15 of its commodity vendors into the newly developed supplier governance program by the assigned deadline. - Designed the template and script of the presentation used to promote supplier governance program to internal stakeholders leading to a firmer grasp of the process and its benefits. - Investigated and resolved invoice issues, recapturing additional savings and avoiding future billing errors. - Monitored adherence to company and governance policies leading to process improvement and ensuring all existing and future project priorities aligned with business priorities. Show less

• Risk Analyst

  • 2009 - 2015

  Mitigated risk exposure to the company by partnering with legal departments, business units, and other relevant parties to review contracts, relationships, and processes to assess and resolve the impact to the corporation. - Streamlined the process of tracking risk requests from internal clients leading to a single risk analyst responding to over 100 requests a month with a 3 to 5 day turn around, measurably improving customer satisfaction. - Negotiated the insurance, indemnification, and limitation of liability provisions of agreements, leases, and RFPs until the company’s risk from an insurance and contractual perspective was appropriately transferred. - Centralized and monitored the locally admitted insurance policies of the company’s 13 international subsidiaries and in doing so streamlined the process by which data is gathered for the corporate foreign insurance package which extends to each country. - Coordinated and assisted with the corporate insurance renewals, facilitating premium savings and insurance policies in line with business practices. - Educated internal clients via webinar and face-to-face presentations, facilitating a significant increase in partnerships with multiple business units. Show less

• Paralegal

  • 2006 - 2009

  Provided legal support to business units by conducting front line contract reviews, drafting and negotiations with internal clients and external vendors. - Instrumental in the creation and implementation of the template agreements to be used for all facilities services, leading to a significant decrease in turnaround times and increased client satisfaction. - Developed and implemented a contract administration process to track all outstanding documentation needed to complete each agreement, significantly increasing productivity and shortening the time between submission and completion. - Created a matrix to for hold harmless agreements, streamlining the process by which special events were reviewed by legal and risk management resulting in a significant reduction in erroneous requests. Show less



Structured Asset Funding

• United States
• 1 - 100 Employee

• Paralegal

  • 2005 - 2006

  Administered multiple stages in the contracting process by drafting seller documents and contracts and subsequently conducting comprehensive underwriting reviews of all incoming executed contracts and documents to determine whether they complied with statutory and facility requirements. Administered multiple stages in the contracting process by drafting seller documents and contracts and subsequently conducting comprehensive underwriting reviews of all incoming executed contracts and documents to determine whether they complied with statutory and facility requirements.



Peachtree Settlement Funding

• Compliance Analyst

  • Aug 2001 - Jan 2005

  Served as lead compliance analyst required to identify the missing documentation required to get each customer file through the stages of the pipeline. Supervised a team of 12 Contract Back Specialists whose primary objective was the gather said documentation from each customer, government agency, or third party. - Collaborated with customers and annuity owners, fostering strong relationships which facilitated in obtaining the documentation necessary to get files successfully funded and allocated. - Drafted special affidavits supporting each transaction which were reviewed judges at the court hearings, the contents of which largely determined approval in favor of the transfer. - Managed the cash advance process for new and existing customers, analyzing the risk and cost, and determining approval or denial. Show less



Nortel Networks

• Telecommunications
• 700 & Above Employee

• Recruiting Coordinator

  • 1999 - 2001

  * Sent offer letters to candidates under consideration for hire, as well as having coordinated all travel and scheduling activities for said candidate’s interview process. * Made certain that candidates received offer, as well as New Hire, information in a timely and professional manner. * Presented Nortel History piece at New Hire Orientation. Served as Benefits Presentation back up. * Assisted in the transition of the Q-tera Recruiting Process to the Nortel Recruiting Process. * Sent offer letters to candidates under consideration for hire, as well as having coordinated all travel and scheduling activities for said candidate’s interview process. * Made certain that candidates received offer, as well as New Hire, information in a timely and professional manner. * Presented Nortel History piece at New Hire Orientation. Served as Benefits Presentation back up. * Assisted in the transition of the Q-tera Recruiting Process to the Nortel Recruiting Process.


Singer Asset Finance
• United States
• Financial Services
• Sales Coordinator

  • 1997 - 2000