Experience

The Rawlings Group

• United States
• Insurance
• 700 & Above Employee

• Client Services Manager

  • May 2021 - Present



DentaQuest

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

• Provider Partner

  • Jan 2019 - Dec 2020

  • Managed a network of over 1,000 dentists and dental offices (including two dental schools) to improve their understanding of all available benefit programs by resolving benefit and claims issues, reprocessing of claims, resolving enrollment issues, re-negotiating reimbursement schedules, and ensuring CMS compliance. • Project lead for recruiting and re-contracting managed care providers with Medicaid, Medicare Advantage, and commercial lines of business in the South East region (Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Tennessee, West Virginia). • Contributed to Anthem’s business development and RFP strategies in the Kentucky market to secure a 5-year Medicaid contract. • Project Manager for the integration and enrollment of Arrow Dental Partners DSO with up to 200 offices in Kentucky and growing. • Negotiated special deals and Special Case Agreements, with out-of-network providers, to maintain compliance and increase access in weak networks. • Promoted dentist adoption of technology solutions by promoting Web applications, conducting Provider Portal trainings, and increasing the volume of electronic claims and electronic remittance to satisfy the Go Green project. • Represented the Client and DentaQuest at DAC and TAC state meetings, trade shows, health fairs, and dental summits throughout the state.



Commonwealth Health Corporation

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

• Provider Relations

  • Jan 2018 - Jan 2019

  • Liaison between healthcare providers and managed care divisions, including largest Kentucky healthcare system and Medicaid organization. Market network participation by interpreting provisions of health plans, securing contracts, enrolling providers, and facilitating credentialing. Respond to high volume of client inquiries promptly, researching causative factors, and using independent judgment to resolve issues tactfully. • Project Manager for several HMO contracting measures, responsible for planning and overseeing projects to ensure accurate and timely completion. • Built and maintained rapport with WellCare of Kentucky, largest health plan client of 400,000+ members • Built and maintained rapport with Humana, Passport, United Healthcare, Cigna, Aetna, and Molina • Project lead in streamlining Provider MAP811 (Medicaid) applications processing • Project lead in reimbursement negotiation for Norton Children’s Hospital Outpatient Center • Co-Project lead in value based and path to value contracting project implementation • Authored Contracting Policies and Procedures Manuals • Proficient in Microsoft Office Suite, NCQA accreditation, CAQH data source, and client database, CACTUS



Self-Employed

• Kentucky, United States

• Business Development and Listing Manager

  • Aug 2015 - Jan 2018

  • Operations Manager at Style&Heart (online boutique) with research, marketing and communications strategies to grow the business and prepare the store for opening. • Listing Manager at The Elizabeth Monarch Group with Keller Williams Realty, Louisville: listing properties, contract-to-close processing of contracts, and training new talent to grow the business. • Operations Manager at Style&Heart (online boutique) with research, marketing and communications strategies to grow the business and prepare the store for opening. • Listing Manager at The Elizabeth Monarch Group with Keller Williams Realty, Louisville: listing properties, contract-to-close processing of contracts, and training new talent to grow the business.



ICTY

• Netherlands
• Administration of Justice
• 100 - 200 Employee

• Media and Communications

  • Jan 2015 - Jul 2015

  • Assisted the team of the Communications Section responsible for communicating the efforts of the tribunal to the tribunal and to the news networks and public. Responsible for maintaining thorough communication between the tribunal and the public. • Assisted the team of the Communications Section responsible for communicating the efforts of the tribunal to the tribunal and to the news networks and public. Responsible for maintaining thorough communication between the tribunal and the public.



AMERICAN EAGLE OUTFITTERS INC.

• United States
• Retail
• 700 & Above Employee

• Assistant Store Manager Operations

  • Mar 2014 - Dec 2014

  • Recruiting, hiring, developing and retaining top sales talent for the store, to including the maintenance of optimal staffing levels; consistently assessing and providing ongoing performance feedback to all levels of the store team; and executing the store business plan with tight deadlines, that drives KPI results and maximizes business opportunities to drive at least $3.5million annually. • Recruiting, hiring, developing and retaining top sales talent for the store, to including the maintenance of optimal staffing levels; consistently assessing and providing ongoing performance feedback to all levels of the store team; and executing the store business plan with tight deadlines, that drives KPI results and maximizes business opportunities to drive at least $3.5million annually.



ShopHQ

• United States
• Broadcast Media Production and Distribution
• 200 - 300 Employee

• Customer Service

  • Jul 2012 - Mar 2014

  Utilized EVINE Live (Oracle, PTOC) and client reference information and computer software for data entry in investigating and updating activity on customer accounts, while resolving customer order issues. Utilized EVINE Live (Oracle, PTOC) and client reference information and computer software for data entry in investigating and updating activity on customer accounts, while resolving customer order issues.