New Provider contracting and servicing existing network providers.

Full service licensed broker with access to the best health and life policies in the country. Offering private health insurance and market place health plans. Currently holding a Florida,Michigan, New Mexico, Texas,Tennessee and Ohio licenses. Contact me at 352-289-1620 for health and life insurance options!

• Led the project to build and configure all contract templates for the newly acquired Harvard Pilgrim plan in the IKA system as well as the new Health Axis system. • Maintained close relationships and communicated daily with business partners, i.e. credentialing, claims, provider network managers and provider relations.• Responsible for researching and interpreting ancillary and hospital contracts to load and configure the reimbursement methodology in the IKA and Health Axis claims system for accurate claims adjudication.• Specialized in resolving daily complex institutional and ancillary claim issues.• Responsible for updating quarterly and/or biannual Medicaid/Medicare published rates for all ancillary and hospital providers. • Pulled and reviewed daily claim reports for possible claims issues.• Significantly contributed in the reduction of claim pends and brought them to manageable levels.• Served as subject matter expert for all plans and lines of business.• Responsible for researching CMS policies and requirements for hospitals and ancillary providers

• Timely and accurately loading of provider contracts and maintaining data for accurate claims payment for multiple physician groups.• Researched, validated and evaluated individual physician and group data in various information systems for accuracy.• Handled the four core processes consisting of physician registrations, terminations, data maintenance and contracting for HMO, PPO, PPS(traditional), and Medicare products.• Handled all processes in creating and terminating physician groups and associations• Selected as a representative of the Document Control Committee to review and update Standard Operating Procedures.• Promoted to the dedicated group team to handle high volume, high complex provider contract loads and data maintenance.• Evaluated dedicated group transactions to suggest or implement process improvements.