Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Network Market Manager

  • Jul 2022 - Present



Ubiquity

• United States
• Outsourcing and Offshoring Consulting
• 700 & Above Employee

• Healthcare Account Manager

  • Dec 2021 - Mar 2022

  Responsible for managing the relationship between Ubiquity and U.S. healthcare clients which are predominantly payers within the U.S. managed care vertical: Medicare, Medicaid, and delegated at-risk entities. Responsible for knowing and understanding client expectations and value propositions as documented in legal documents such as Scope of Work and subsequent Business Rule Documents. Responsibilities further included collaborating with internal teams (Operations, IT, etc.) to ensure service delivery met contracted and market standards. Client advocate within internal teams often working with large amounts of production data with the expectation to communicate key performance indicators within data reports to clients. This role required strong written and verbal communication skills and the ability to develop and maintain an open and long lasting relationship, even in the most difficult and high-pressured situations.



AmeriHealth Caritas

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

• Account Executive, Provider Network Management

  • Aug 2018 - Sep 2021

  Managed Medicaid/Medicare - Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers. Maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Network Relations Liaison

  • Jul 2017 - Aug 2018

  Aetna Better Health Managed Medicaid - Acted as the primary resource for assigned, high profile providers or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Managed a 12 county territory for physician, hospital, and ancillary services. Aetna Better Health Managed Medicaid - Acted as the primary resource for assigned, high profile providers or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Managed a 12 county territory for physician, hospital, and ancillary services.



Provider Resources, Inc.

• United States
• Government Relations Services
• 1 - 100 Employee

• Training Specialist Supervisor/Coordinator

  • Nov 2013 - Mar 2017

  Developed, coordinated and implemented corporate compliance and role based training to staff supporting the entity conducting Federally-facilitated Marketplace and State-based Marketplace appeals for the Eligibility Appeals Operations Support tasks under the Affordable Care Act (ACA). Lead a team of trainers who facilitated one-on-one, small and large group trainings for appeals specialists, customer service representatives, attorney SMEs, operations managers/supervisors and federal hearing officers. Consulted with operations to access training needs and determine most effective approach for delivery. Created training & project plans and supervised consultant implementation training teams. Reviewed training survey information to prioritize areas of improvement. Routinely collaborated with department managers to correct problems and improve services. Encouraged creative thinking, problem solving and empowerment as part of the leadership team to improve morale and teamwork. Developed departmental goals, objectives, standards of performance, policies and procedures. Evaluated employee performance and conducted regular reviews providing comprehensive feedback to foster ongoing growth. Recorded employee attendance, personal and vacation time and reported all leaves of absence to the benefits department on a regular basis. Learning management system (LMS) admin responsible for uploading training courses and applicable materials, monitoring trainee attendance and performance, running reports and accessing additional training needs based on report trends.



NHIC, Corp.

• Hingham, MA

• Provider Outreach & Education Consultant

  • Jul 2005 - Feb 2012

  Liaison between the provider/supplier community and the Medicare program with regard to reimbursement, credentialing, claims, EDI web site procedures, and issues of key providers. Facilitate resolution of complex contractual and provider/supplier issues, collaborating with internal departments and the Centers for Medicare & Medicaid Services (CMS) as necessary. Liaison between the provider/supplier community and the Medicare program with regard to reimbursement, credentialing, claims, EDI web site procedures, and issues of key providers. Facilitate resolution of complex contractual and provider/supplier issues, collaborating with internal departments and the Centers for Medicare & Medicaid Services (CMS) as necessary.



HealthNow New York Inc.

• United States
• Insurance
• 400 - 500 Employee

• Ombudsman

  • Nov 1999 - Jun 2005

  Liaison between the provider/supplier community and the Medicare program with regard to reimbursement, credentialing, claims, EDI web site procedures, and issues of key providers. Facilitate resolution of complex contractual and provider/supplier issues, collaborating with internal departments and the Centers for Medicare & Medicaid Services (CMS) as necessary. Liaison between the provider/supplier community and the Medicare program with regard to reimbursement, credentialing, claims, EDI web site procedures, and issues of key providers. Facilitate resolution of complex contractual and provider/supplier issues, collaborating with internal departments and the Centers for Medicare & Medicaid Services (CMS) as necessary.



Intermountain Medical Group

• Kingston, Pennsylvania

• Medical Assistant (Clinical)

  • Nov 1996 - Nov 1999

  Verify patient information by interviewing patient, recording medical history, and confirming purpose of visit. Prepared patients for examination by performing preliminary physical tests; taking blood pressure, weight, and temperature; and reporting patient history summary. Performed phlebotomy and EKG procedures. Assisted practitioner with exams and additional procedures, as needed. Verify patient information by interviewing patient, recording medical history, and confirming purpose of visit. Prepared patients for examination by performing preliminary physical tests; taking blood pressure, weight, and temperature; and reporting patient history summary. Performed phlebotomy and EKG procedures. Assisted practitioner with exams and additional procedures, as needed.