Experience

ComplyFirst, LLC

• United States
• Pharmaceutical Manufacturing

• Manager of Provider Relations

  • Jul 2018 - Present

  • Leads the provider relations department by managing provider relationships • Answer practitioners/facility questions regarding enrollment, policies and procedures • Manage a provider network of 8,000 plus • Negotiates contracts between physicians and ComplyFirst LLC • Focuses on increasing gross profit by expanding physician network • Perform research and problem resolution on issues related to provider complaints, authorizations reported to have been processed incorrectly, provider communications or verification of information as requested. Review and analyze provider information and status though database queries • Prepares reports as requested by management using internal software • Strong technical aptitude and a demonstrated ability to succeed in a fast-paced, constantly changing environment • Ensure all provider distribution lists are maintained • Manages network using Salesforce software tools Show less



EmblemHealth

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

• Faculty Program Admin

  • Jan 2016 - Dec 2017

  • Served as the primary point of contact between EmblemHealth and NYC hospitals • Created Ad Hoc reports using SQL, Tableau and business intelligence software • Supervised projects to ensure that workflow ran smoothly • Acted as the primary contact person for annual state audits and provider credentialing • Managed relationships with management, administrators, vendors, and consultants • Researched and resolved escalated provider inquiries related to reimbursement • Developed project status reports for the medical economics team to review • Conducted meetings to resolve ongoing contractual and reimbursement issues • Worked closely with management to improve revenue cycle and website discrepancies • Investigated potential cases of fraud and created reports for compliance • Investigated cases of fraud billing and handled member complaints Show less