Experience

myNEXUS®

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

• Provider Network Contract Manager

  • Jan 2022 - Present

• Provider Network Manager | Account Executive

  • Apr 2020 - Jan 2022



Aetna, a CVS Health Company

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

• Contract Negotiator/Network Relations

  • Jun 2019 - Apr 2020

  • Negotiate, execute, review, and analyze contracts.• Responsible for rate and language negotiation for assigned territory• Handle dispute resolution and settlement negotiations in accordance with company standards.• Ensure resolution of escalated issues related to claims payment, contract interpretation and parameters and accuracy of provider demographic information.• Manage contract performance in support of network quality/financial goals and strategies.• Recruit providers as needed to ensure attainment of network expansion and adequacy targets.• Provide network development, maintenance for designated market



Azura Vascular Care

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

• Senior Data Analyst

  • Jul 2018 - Jun 2019

  • Perform financial rate analysis for every new ASC/PRO payer contract project and discuss with Portfolio Manager aggregate rate lift results.• Schedules and presents all financial analysis and language reviews with VP for discussion and approval.• Develop counter proposals to be sent back to payers for ASC contracting efforts.• Perform payer contract review for each ASC contract to ensure appropriate language is secured.• Schedules and presents all financial analysis and language reviews with VP for discussion and approval.• Update all contract negotiation activity in cloud base workflow tool Wrike.• Responsible for maintaining all relevant fee schedule methodologies include but not limited to MCARE, MCAID, TRICARE, proprietary payer values.• Responsible for pulling all payer and service mixes for ASC analysis.• Develops and provides revenue cycle electronic fee schedules and NextGen templates for system contract loading and maintenance.

• Managed Care Data Analyst

  • Jul 2017 - Jun 2019



United Surgical Partners International, Inc

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

• Managed Care Coordinator

  • May 2013 - Jul 2017

  • Assist USPI facilities and Central Billing Offices with escalated claims resolutions.• Managed and track escalated issues.• Contract coordinator and expert by providing timely and accurate information, as well as education, to internal and external customers to optimize managed care strategies and maximize financial profitability.• Coordinates, educates, monitors, and ensures accurate implementation of complex managed care contracts for each USPI facility and Central Billing Offices (CBO) for a given region.• Utilizes tools to trend issues and ensure contract compliance.• Responsible for projects improving operational effectiveness.• Ensure the operational efficiency of negotiated contract terms.• Complete and submit ASC and Hospital credentialing