Experience

• 

  Integrated Home Care Services, Inc.

  • United States
  • Home Health Care Services
  • 100 - 200 Employee

  • Provider Network/Credentialing Team Lead

    • Mar 2024 - Present

    • Prepares or proofreads various reports, letters, memoranda, and statistical charts; independently composes correspondence, letters, resolutions, and reports as assigned.• Review finished materials for completeness, accuracy, format, compliance with policies and procedures, and appropriate grammar.• Maintains a calendar of activities, meetings, and various events for credentialing activities and audits.• Organizes meetings and prepares required informational material.• Participates in the preparation and organization of delegation audits.• Tracks and ensures Credentialing and Licensing processes are completed timely. Identifies and notifies employees who may need updating or re-credentialing and processes accordingly.• Communicates credential requests, status, and any issues to the Corporate Compliance Director• Supervising the credentialing process for healthcare providers, ensuring adherence to industry standards and regulations.• Managing contract negotiations with healthcare providers, payers, or vendors to secure favorable terms and conditions.• Ensuring all credentialing and contracting activities comply with relevant laws, regulations, and organizational policies.• Leading and managing a team in credentialing and contracting tasks, providing guidance, training, and support.• Building positive relationships with healthcare providers, payers, and other stakeholders.• Implementing quality assurance measures to ensure accuracy and completeness in the credentialing process.• Developing and updating policies and procedures related to credentialing and contracting activities.• Collaborating with other departments, such as legal, finance, and operations, to streamline processes and resolve issues.• Establishing and monitoring key performance indicators to assess the efficiency and effectiveness of the credentialing and contracting team.

  • Provider Network Specialist II

    • Apr 2023 - Mar 2024

    • Strategizes positioning for contracting with providers and developing networks in outlying areas.• Initiates and maintains effective communication channels with providers and internal and external customers.• Manages contracting with providers (e.g., Ancillaries – Home Health, DME, and IV).• Conducts negotiations and drafts individual and group contracts.• Ensures the smooth operation and administration of provider agreements.• Demonstrates knowledge of Providers in assigned geographic areas. Have a demonstrated understanding of the relationships between Health plans, Providers, and Referral sources in the local market.• Works in the field promoting and marketing the company’s homecare services.• Establishes and develops new business contacts.• Maintains current relationships.• Works with current and prospective clients, including physicians, hospitals, home health agencies, clinics, and other potential referral resources in specified territory.• Maintains effective time management, promotes excellent customer service, and supports the company’s culture at all times.• Ongoing product/service knowledge.• Identifies client needs and offers viable solutions.• Keeps detailed records of all contacts.• Plans work schedules with weekly and monthly objectives.• Demonstrates proficient administrative, phone, and data entry skills.• Train staff in MedTrac and new processes.• Writes department Guides and test systems.

  • Provider Network Development Specialist I

    • Mar 2022 - Apr 2023

    • Responsible for managing provider networks and relationships with providers across the state.• To be organized, analytical, and able to communicate and negotiate with providers effectively• Think strategically to develop optimal provider networks• Monitor provider contracts and performance to ensure compliance with established standards• Collaborate with internal departments to ensure provider needs are addressed• Analyze data and make recommendations to optimize provider networks.• Develop and maintain relationships with providers.• Monitor changes in the industry and adjust networks to meet changing needs.

  • Provider Network Development Specialist

    • Jul 2020 - Mar 2022

    • Responsible for managing provider networks and relationships with providers across the state.• To be organized, analytical, and able to communicate and negotiate with providers effectively• Think strategically to develop optimal provider networks• Monitor provider contracts and performance to ensure compliance with established standards• Collaborate with internal departments to ensure provider needs are addressed• Analyze data and make recommendations to optimize provider networks.• Develop and maintain relationships with providers.• Monitor changes in the industry and adjust networks to meet changing needs.

• 

  MTI America

  • United States
  • Hospitals and Health Care
  • 200 - 300 Employee

  • Provider Relations Specialist Team Lead

    • Oct 2019 - Apr 2020

    • Reporting to management weekly about network development, credentialing files not being met, and scheduling meetings.• Ensures contractual agreements are met.• Develop alternatives, strategies, and plans of action to facilitate the negotiation process.• Works independently and as part of a team on contract negotiations, renegotiations, contract preparation, provider relations, and recruitment.• Ensure quality service delivery components and patient/carrier satisfaction with services provided.• Initially establishes provider relationships and prepares handoff to the account management team. • Participate in the process for continuous credentialing and quality monitoring of assigned accounts.• Works with team to identify margin opportunities by analyzing out-of-network utilization and using data to identify network development opportunities.• Identifies potential vendors for recruitment into the MTI’s Management network.

  • Transportation Network Administrator

    • Feb 2017 - Oct 2019

    • List new job postings nationwide and create contracts with new drivers and transport companies.• Verify insurance, vehicle registrations, transit, and sexual predator violations.• Coordinate with independent drivers and transport companies, ensuring the injured worker reaches their destination.• Organize real-time pickups nationwide with clients and drivers and calculate rates and mileages.• Investigate unsatisfactory cases to avoid similar instances for future appointments.• Report and assist the floor manager with current situations and resolutions of live events. • Provide constant communication with coworkers and employees to ensure synergy.• Cooperate with other departments within the company to guarantee optimal satisfaction.

  • Transportation Dispatcher

    • Feb 2015 - Feb 2017

    • Confirm next-day assignments with drivers.• Assist with routing drivers.• Assist in handling inbound and outbound live calls.• Assist drivers with closing daily work orders.• Any additional tasks/projects asked by management.• Confirm or cancel future appointments with drivers, companies, doctors, and legal establishments