Experience

HMSA

• United States
• Insurance
• 200 - 300 Employee

• Travel Manager

  • Feb 2020 - Present



OHANA HEALTH PLAN

• United States
• 1 - 100 Employee

• Provider Relations Manager

  • Jul 2008 - Feb 2020

  - Provider Operations Coordinator: Scrub and obtain missing documents for Provider credentialing applications. Data entry provider contracts.Assist in developing implementation of Ohana Health Plan, a health insurance company to the Hawaii market. - Provider Relations Rep:Manage assigned participating providers in territory. Recruit new providers, expand lines of business, and encourage open panel. Provide bi annual education. Deliver HEDIS and member frequent flyer reports, as well as address claim and other issues the provider may have with the plan.- Provider Operations Supervisor:Managed physician contract loads in the Hawaii market. Maintain credential and re- credentialing contract specifics. Help to develop and implement new lines of business such as TANF- Provider Relations Manager:Manage, maintain, and enrich State Wide Physician and Facility network. Work in concert with medical economics and clinical team providing updates and provider education twice a year. Enhance provider experience by overseeing the distribution of reports such as HEDIS, prudent financial, and patient reports to contracted vendors and IPAs. Negotiate contract agreements and language, higher reimbursements, single case, and letter of agreements with contracted and non par providers. Manage a team of seven statewide field based Provider Representatives.



ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII

• Hospitals and Health Care
• 1 - 100 Employee

• Biller, Hospital Claims

  • 1992 - 2008

  - PBX Operator- Admissions Clerk- Cashier- Financial Counselor- Follow Up Collections - In Patient Biller - PBX Operator- Admissions Clerk- Cashier- Financial Counselor- Follow Up Collections - In Patient Biller