Experience

Cypress Healthcare Consultants

• United States
• Insurance
• 1 - 100 Employee

• Senior Consultant

  • May 2019 - Present

  Network Development Executive responsible for developing and implementing the methodology which results in competitive contract pricing while maintaining a broad network of hospitals, physicians, behavioral health and ancillary providers on a nationwide basis. Duties include directing and overseeing contracting, provider relations activities, network directories, database management and reporting. Network Development Executive responsible for developing and implementing the methodology which results in competitive contract pricing while maintaining a broad network of hospitals, physicians, behavioral health and ancillary providers on a nationwide basis. Duties include directing and overseeing contracting, provider relations activities, network directories, database management and reporting.



ATTAC Consulting Group (ACG)

• United States
• Business Consulting and Services
• 1 - 100 Employee

• Consultant

  • Dec 2018 - May 2019

  Network Development Consultant with extensive contracting and provider relations background, with more than 10 years of contract management and reimbursement experience in the physician, hospital and payer setting. Passionate about contracting, provider relations and provider servicing with proven success in all three areas. Network Development Consultant with extensive contracting and provider relations background, with more than 10 years of contract management and reimbursement experience in the physician, hospital and payer setting. Passionate about contracting, provider relations and provider servicing with proven success in all three areas.



Zelis

• United States
• Technology, Information and Internet
• 700 & Above Employee

• Network Enrollment Manager

  • Feb 2015 - Dec 2016

  Establish network development strategies to meet corporate objectives of growing a national provider network Work with the data analytics department to develop targets and lead lists for recruitment Lead recruitment efforts of healthcare providers (phone, e-mail, and fax) Develop provider value proposition to be promoted to providers during recruitment process Foster and maintain provider relationships to preserve existing participation in network. Overcome provider… Show more Establish network development strategies to meet corporate objectives of growing a national provider network Work with the data analytics department to develop targets and lead lists for recruitment Lead recruitment efforts of healthcare providers (phone, e-mail, and fax) Develop provider value proposition to be promoted to providers during recruitment process Foster and maintain provider relationships to preserve existing participation in network. Overcome provider objections to reach successful outcomes Responsible for negotiating, implementing and maintaining provider contracts Show less Establish network development strategies to meet corporate objectives of growing a national provider network Work with the data analytics department to develop targets and lead lists for recruitment Lead recruitment efforts of healthcare providers (phone, e-mail, and fax) Develop provider value proposition to be promoted to providers during recruitment process Foster and maintain provider relationships to preserve existing participation in network. Overcome provider… Show more Establish network development strategies to meet corporate objectives of growing a national provider network Work with the data analytics department to develop targets and lead lists for recruitment Lead recruitment efforts of healthcare providers (phone, e-mail, and fax) Develop provider value proposition to be promoted to providers during recruitment process Foster and maintain provider relationships to preserve existing participation in network. Overcome provider objections to reach successful outcomes Responsible for negotiating, implementing and maintaining provider contracts Show less



Horizon NJ Health

• United States
• Insurance
• 100 - 200 Employee

• Network Specialist/Contractor

  • May 2014 - Feb 2015

  Responsible for negotiating, implementing and maintaining contracts between HNJH and assigned Managed Long Term Services and Supports (MLTSS) providers which may include but not be limited to, Personal Care Agencies, Medical Day Centers, Nursing Facilities, Community Alternative Residential Settings and Non-Traditional providers ensuring that the contractual arrangement is fulfilled. As MLTSS Network Specialist I am expected to develop contract arrangements ensuring all requirements… Show more Responsible for negotiating, implementing and maintaining contracts between HNJH and assigned Managed Long Term Services and Supports (MLTSS) providers which may include but not be limited to, Personal Care Agencies, Medical Day Centers, Nursing Facilities, Community Alternative Residential Settings and Non-Traditional providers ensuring that the contractual arrangement is fulfilled. As MLTSS Network Specialist I am expected to develop contract arrangements ensuring all requirements are detailed in contract language, executed and implemented in a timely fashion. Maintain oversight of contracted arrangements ensuring that credentialing, reporting and quality standards are met. Renew existing contracts using analysis of cost and utilization data, gaps in service and quality reports to ensure MLTSS network adequacy at efficient prices. Educate, monitor, analyze, document and interact with MLTSS providers to ensure cooperation, understanding and effective participation in HorizonNJHealth. Show less Responsible for negotiating, implementing and maintaining contracts between HNJH and assigned Managed Long Term Services and Supports (MLTSS) providers which may include but not be limited to, Personal Care Agencies, Medical Day Centers, Nursing Facilities, Community Alternative Residential Settings and Non-Traditional providers ensuring that the contractual arrangement is fulfilled. As MLTSS Network Specialist I am expected to develop contract arrangements ensuring all requirements… Show more Responsible for negotiating, implementing and maintaining contracts between HNJH and assigned Managed Long Term Services and Supports (MLTSS) providers which may include but not be limited to, Personal Care Agencies, Medical Day Centers, Nursing Facilities, Community Alternative Residential Settings and Non-Traditional providers ensuring that the contractual arrangement is fulfilled. As MLTSS Network Specialist I am expected to develop contract arrangements ensuring all requirements are detailed in contract language, executed and implemented in a timely fashion. Maintain oversight of contracted arrangements ensuring that credentialing, reporting and quality standards are met. Renew existing contracts using analysis of cost and utilization data, gaps in service and quality reports to ensure MLTSS network adequacy at efficient prices. Educate, monitor, analyze, document and interact with MLTSS providers to ensure cooperation, understanding and effective participation in HorizonNJHealth. Show less



RWJBarnabas Health

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

• Physician Contract Officer- Compliance

  • May 2012 - May 2014

  Report directly to the Chief Compliance Officer and Chief Operating Officer. Responsible for providing oversight of all aspects of establishing and maintaining physician financial relationships. In this position I am expected to: Have a strong working knowledge of Corporate Compliance Physician Contracting Policy: Contracts/Financial Arrangements with Physician and Non-Physician Referral Sources. Have a strong understanding of the Stark and Anti-Kickback guidelines, IRS… Show more Report directly to the Chief Compliance Officer and Chief Operating Officer. Responsible for providing oversight of all aspects of establishing and maintaining physician financial relationships. In this position I am expected to: Have a strong working knowledge of Corporate Compliance Physician Contracting Policy: Contracts/Financial Arrangements with Physician and Non-Physician Referral Sources. Have a strong understanding of the Stark and Anti-Kickback guidelines, IRS compensation rules (i.e. employee versus 1099 relationships), medical director guidelines when contracting with a group, regulatory requirements for program directors & chairpersons relating to residencies & medical education, etc Have a strong working knowledge of the Corporate Guidelines for Physician Compensation. Know how the corporate compensation schedules are developed and what they mean. Have strong understanding of Fair Market Value methodologies and analysis according to regulations. Familiarity with MGMA, AMGA, SCA, AAMC and other benchmarks. Demonstrate the ability to understand and implement productivity models based on either WRVU’s or Collections from professional services Draft job description, term sheets and other supporting documents for physician recruiting. Coordinate offer letter process, human resource requirements, medical staff requirements, risk management issues, payor credentialing, etc. Follow-up on all correspondence in a timely manner. Work with the legal department on contract as process evolves Establish and maintain a central location (database) for all contracts with potential referral sources. Track expenses (salary and bonus payments) authorized in contract Show less Report directly to the Chief Compliance Officer and Chief Operating Officer. Responsible for providing oversight of all aspects of establishing and maintaining physician financial relationships. In this position I am expected to: Have a strong working knowledge of Corporate Compliance Physician Contracting Policy: Contracts/Financial Arrangements with Physician and Non-Physician Referral Sources. Have a strong understanding of the Stark and Anti-Kickback guidelines, IRS… Show more Report directly to the Chief Compliance Officer and Chief Operating Officer. Responsible for providing oversight of all aspects of establishing and maintaining physician financial relationships. In this position I am expected to: Have a strong working knowledge of Corporate Compliance Physician Contracting Policy: Contracts/Financial Arrangements with Physician and Non-Physician Referral Sources. Have a strong understanding of the Stark and Anti-Kickback guidelines, IRS compensation rules (i.e. employee versus 1099 relationships), medical director guidelines when contracting with a group, regulatory requirements for program directors & chairpersons relating to residencies & medical education, etc Have a strong working knowledge of the Corporate Guidelines for Physician Compensation. Know how the corporate compensation schedules are developed and what they mean. Have strong understanding of Fair Market Value methodologies and analysis according to regulations. Familiarity with MGMA, AMGA, SCA, AAMC and other benchmarks. Demonstrate the ability to understand and implement productivity models based on either WRVU’s or Collections from professional services Draft job description, term sheets and other supporting documents for physician recruiting. Coordinate offer letter process, human resource requirements, medical staff requirements, risk management issues, payor credentialing, etc. Follow-up on all correspondence in a timely manner. Work with the legal department on contract as process evolves Establish and maintain a central location (database) for all contracts with potential referral sources. Track expenses (salary and bonus payments) authorized in contract Show less



Memorial Sloan Kettering Cancer Center

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

• POA

  • 2010 - 2012

  Administration and Coordination: •Knowledge of vendor management and negotiations •Handle check requests and purchase orders Management/Training •Manage academic and research oriented medical practice •Mentored new employees; monitor progress and development •Participated on the Talent Task Force for the Department of Surgery •Administer data analysis and generate Excel worksheet presentation •Manage multiple offices when there is staff… Show more Administration and Coordination: •Knowledge of vendor management and negotiations •Handle check requests and purchase orders Management/Training •Manage academic and research oriented medical practice •Mentored new employees; monitor progress and development •Participated on the Talent Task Force for the Department of Surgery •Administer data analysis and generate Excel worksheet presentation •Manage multiple offices when there is staff shortage Problem Solving/ Relationship Management •Resolve in-depth queries with external parties to find appropriate resolutions, efficiencies, and high level of quality •Maintain direct and indirect client relations as primary point of contact for patients •Extensive experience with insurance companies •Refine planning and organizational skills to balance work, team support, and ad-hoc responsibilities Show less Administration and Coordination: •Knowledge of vendor management and negotiations •Handle check requests and purchase orders Management/Training •Manage academic and research oriented medical practice •Mentored new employees; monitor progress and development •Participated on the Talent Task Force for the Department of Surgery •Administer data analysis and generate Excel worksheet presentation •Manage multiple offices when there is staff… Show more Administration and Coordination: •Knowledge of vendor management and negotiations •Handle check requests and purchase orders Management/Training •Manage academic and research oriented medical practice •Mentored new employees; monitor progress and development •Participated on the Talent Task Force for the Department of Surgery •Administer data analysis and generate Excel worksheet presentation •Manage multiple offices when there is staff shortage Problem Solving/ Relationship Management •Resolve in-depth queries with external parties to find appropriate resolutions, efficiencies, and high level of quality •Maintain direct and indirect client relations as primary point of contact for patients •Extensive experience with insurance companies •Refine planning and organizational skills to balance work, team support, and ad-hoc responsibilities Show less