Ashley Sailer, Cpcs Email & Phone Number

Fargo, North Dakota, United States

Develops clear and effective project plans to manage program design, data collection, data analysis and value-based program implementation. Leverages and monitors data to initiate provider discussions around contract performance issues and provide meaningful insights to providers on targeted focus areas to improve financial and quality performance.Establishes communication plans and prepares strategic planning documents, project proposals, and internal review reports for value-based care initiatives.Leads interdepartmental teams to support and champion the development and ongoing monitoring of value-based programs.Evaluates program effectiveness by collecting and analyzing data in support of key performance metrics. Develops, implements, and evaluates program success metrics to help guide program adjustments and/or enhancements.Supports leadership and actively participates in discussions with clients and brokers regarding value-based payment programs.Reviews contract performance against expectations and helps guide future alternative payment model direction to strengthen our value proposition, improve our competitive position, and meet goals and objectives.

Fargo, North Dakota, United States

Leads all aspects of Provider Relations to include provider relations and operations to support provider service, provider education, and product and market expansions.Creates efficiencies for offices decreasing the administrative obstacles and assists in developing educational programs for staff and providers.Leads, develops, and trains staff to educate key individuals in provider groups regarding new approaches, products, reimbursement methodologies, appropriate coding including risk scores, quality measures and policy standards changes.Ensures effective and timely provider communication, education and resolution of provider concerns.Develops and implements a community outreach strategy with network providers including a communication plan to keep them informed of current issues.Develops strong relationships with outside partners, such as vendors and advisors, as well as internal partners, including department supervisors and co-executives.Responsible for Provider Relations Team in managing strong working relationships with all providers; this may include in-office visits and out-of-office meetings with providers.Develops innovative initiatives to enhance internal efficiency and effectiveness.Formulates training programs for the Provider Relations Team.Maintains efficient team structure and performance through analytics, processes and tools; maximizing new provider engagement; and working with the leadership team to develop plans to meet future needs.Manages Provider Relations and Representatives and redirects activities as necessary.

Highlands Ranch, Colorado, United States

Creation and Development of Credentialing & Contracting Department.Responsible for management and oversight of Credentialing TeamAssisting in negotiating and managing fee-for-service (FFS) and Value-based care (VBC) contract on behalf of OnPoint with payers, including but not limited to Commercial, Medicare, MA, Medicaid and government programs. Collaborator with leadership to devise payer strategies that align with organizational goals including market access and financial strength. This includes evaluation and initiation of new FFS & VBC contract opportunities, business models and payers’ relationships. Negotiate FFS terms working in conjunction with Data Analysis Team, when needed, to develop financial models to analyze payers FFS proposals. Assess risk exposure, potential upside and downside opportunities and coordinate feedback from President and Financial staff. Monitor and manage FFS & VBC payer compliance including roster updates, reports, deliverables, expireables, and audits. Monitor and analyze changes in payer FFS & VBC programs and policies that may affect contract performance and initiate negotiations as warranted. In conjunction with Revenue Cycle report to payers on any discrepancies on reimbursement and monitor until resolved.

Responsible for management and oversight of the provider credentialing function including supervision of personnel, staff education, and training. Developing, implementing, monitoring, and evaluating all processes and procedures as they relate to operations, making sure they meet the relevant organizational standards. Review financial information and adjust operational budgets to promote profitability. Oversee and collaborate with Credentialing Verification Organization (CVO) for delegated credentialing services.Responsible for overseeing outgoing communications, website creation & maintenance, quarterly newsletter, group purchasing program and education seminars.

Greater Denver Area

Responsible for management and oversight of the provider credentialing function including supervision of personnel, and staff education and training. Oversees the provider education program, group purchasing program, website maintenance, practice communication, and the credentialing function.Responsible for obtaining and maintaining the credentials of providers and is responsible for ensuring compliance with the credentialing process of individual providers.Facilitate bimonthly operational meetings with payers.Serve as a liaison between member practices and payer for problem resolutions, contract disputes, reimbursement issues, and credentialing questions. Oversees the maintenance of the credentialing database and ensures the accuracy of information.Creates and maintains tracking tool for messenger model contracting and communication on a monthly basis with payers and practices related to the messenger model contract status. Acts as a neutral “messenger” between managed care payers and physician providers

Greater San Diego Area

Liaison between individual physicians and their practices, ancillary provider networks, all levels of CPMG staff & management, and other outside entities such as RCHSD, Health Plans, as well as the general public.Receive, research, and respond to unique, complex inquiries from providers and management. Educate providers regarding policies and procedures related to referrals and claims submission; performance data, ER Visits and PMPY. Manage physician and ancillary provider network to include compliance management and regional gap analysis.

Greater San Diego Area

Develop/manage contract relationships with IPAs and MSOs assignedResponsible for the Provider understanding of Care1st products, services and contract detailsConduct appropriate number of Joint Operating Committee (JOC)s per assigned IPAResponsible for timely and professional interaction with Providers and escalates recurring or critical issues, such as quality of care or access by new patients, to appropriate management in a timely fashion.Interprets policies and procedures relating to Care1st relationships with IPAs. Provides interpretation and clarification on benefits interpretation, eligibility and access and authorization inquiries. Responsible for timely and professional interaction with providers and escalates critical issues and re-occurrences to management.Coordinate and resolve all provider/IPA issues, concerns and inquiries, which may involve other departmental areas (Claims, Member Services, Capitation, Benefits, eligibility, etc.)Responsible for terminating provider affiliations, coordinating members to new provider and determining new effective date for providers, along with communicating such to Provider/IPA

San Diego

Administrative support to the VP Medical Services and the Medical Director including drafting/editing letters, mailings, coordinate multiple schedules via Outlook, and AT&T teleconference services. Administrative support for the UM Department, including generating How-To manuals, develop PowerPoint presentations, and assist with timecards.Coordinate logistics for reoccurring and urgent meetings (i.e. Medical Services Committee, Interdisciplinary Care Team (ICT), Project 25, Inpatient Rounds, Behavioral Health, and Gerinet Rounds etc.), including arrange for a room and meal when required, liaison with vendor and providers, prepare meeting packets, and compile and transcribe minutes for internal and external distribution.Review operating practices and procedures in order to determine whether improvements can be made in areas such as workflow and reporting procedures.Designed and implemented transportation form for Care 1st online provider portal to increase efficiency. Form automates manual transportation process for Medicare and Medi-cal members.Assist with arranging transportation needs for Skilled Nursing Facility members.In order to improve process efficiency and data quality, designed and implemented multiple excel forms for outside vendors and internal projects. Projects such as tracking incoming outpatient authorizations; transportation arrangements and execution; and minute templates.Training and supervise 10 employees for the completion of Health Risk Assessment (HRA) with members via phone. Tracked and maintain all HRA records on members.Screen incoming authorization requests, verify member eligibility and benefits, and complete the data entry portion of authorization in MHC.Compose urgent, routine and retroactive denial letters in Care 1st Internal Tracking System (CITS).Compiled materials in preparation for the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) audit.

Morris, Mn

Retrieve patient files, respond to requests for charts, file patient data and maintain patient charts. Provide order communication entry for clinic and ER patients. Prepare and process records for E.H.R. and step up-to-the plate and serve as a switchboard operator when needed.

Crookston, Mn

Provided care for clients such as routine personal care and housekeeping, planned meals (including special diets) and prepared meals, maintained records of services performed and of clients’ condition and progress. Worked in a fast-paced environment, answered multi-line phones, and transferred as directed, maintained computer records, updated company policies and procedures, and assisted with filing and record management. Incorporated new information on bulletin boards to keep staff and residents up-to-date on upcoming events.

Crookston, Mn

Provided support to 3 professionals in the business department, prepared Excel sheets, transcription, organized office supplies and arranged schedules

Glenwood, Mn

Performed budgeting and gained extensive experience shadowing all department personnel, attended board meetings and participated in committees

Glenwood, Mn

Assisted clients with their daily activities of living, Provided assistance for nurses with medical equipment and checked patient vital signs and maintained records of services performed and of client’s condition and progress.

Glenwood, Mn

Engaged in a variety of services including: medication reminders, cleaning, and assisting with showers. Documented services performed and of client’s condition and progress. Also performed housekeeping, laundry, and setting up of dining area.