Barbara B. Email & Phone Number

Remote

Negotiated and executed contracts with managed care payers and other third parties, within financial and language parameters. Reviewed, evaluated new and existing payer contract language compared to corporate language standards. Performed ad-hoc contract language reviews for senior executives. Served as internal resource for responding to payer contract language questions. Worked with actuary to prepare appropriate data analysis for negotiations. Reviewed claims data to analyze performance and resolve any operational issues. Managed planning process for contract negotiations and renewals. Worked with business partners to identify opportunities to address in renegotiations. Facilitated resolution of contract-related claims and operational issues by proactively researching the issues and working with both internal and external customers. Communicated new and revised contract terms to internal customers. Negotiated and executed single case agreements. Maintained database of key language terms by business entity. Developed and maintained department tracking documents database.

Fairfax County, Virginia, United States

Signature Partners ACO: Negotiated competitive network agreement terms and reimbursement methodologies for commercial, Medicare Advantage, TRICARE, SHOP, MSSP ACO and provider Value Based Payer Agreements. Engaged with the quality team and PCPs to improve patient experience. Participated in Joint Operations Committee meetings and in quarterly clinical meetings with PCPs to review performance metrics and areas for improvement. Reviewed terms and financial incentives defined in ACO Payer Agreements including attribution reports and gain share terms. Developed and executed network build-out plans to create marketable, cost-effective networks based on access, quality and cost while assuring patient satisfaction. Initiated the credentialing and re-credentialing process within NCQA guidelines. Liaison for resolution of provider contractual claims payment issues and ensured contract implementation. Established a contract document database, develop contract audit process, and adhere to document retention policy. Performed the dual role of marketing communications manager for Signature Partners. Established marketing brand guidelines, worked with vendors to launch, and maintain the company website, Twitter, and LinkedIn pages. Published the quarterly physician newsletter and was responsible for all collateral to support network recruitment, Quality, and Care Management programs. Wrote copy, edited, developed marketing communications in Word Press and distributed from Campaign Monitor. Maintained a provider email database and was responsible for all events and communications involving network physicians, and our team participation at annual Inova events. Managed vendors for print, fulfillment, promotions, collateral, and the website. *Due to COVID-19 business disruptions the Inova Signature Partners team was laid-off.

Fairfax County, Virginia, United States

Negotiated contract rates and terms with all major health plans, and single-case agreements with local employer and physicians to capture out-of-network services. Analyzed financial performance of contracts and presented quarterly to leadership and worked to establish a strategy to offset any negatives. Collaborated cross-departmentally to facilitate contract terms to teams to ensure appropriate implementation. Worked with payers to resolve issues related to access and payments. Developed a contracts database to track rates and non-standard language to provide dashboard and reporting capabilities to executive team. Worked with outside legal counsel to craft language revisions with the intent of mitigating risk. Ensured practice adherence with the Office of Inspector General compliance guidelines. Resolved escalated patient complaints and implemented best practices. Delivered an internal Customer Service Improvement Program training program for 400+ staff and physicians. Managed the corporate administrative staff of six employees. Received “Star Employee” Award.

Fairfax County, Virginia, United States

Participated in state agency government healthcare managed Medicaid RFI proposals. Collaborated with legal team on contract language. Facilitated the deal review and approval process with executives to ensure Sarbanes-Oxley (SOX) compliance. Negotiated Guarantees, Bonds, and Letters of Credit to define corporate financial obligations. Communicated contract provisions including positive and negative impacts to internal business partners. Contributed to successful government contract proposal submissions by proactively managing bid requirements. Collaborated with cross-functional teams to resolve issues during the contract lifecycle. Established a department SharePoint site to secure SOX compliance contract documents. Created and moderated a WebEx internal series on SOX best practices.

Arlington, Virginia, United States

Wrote copy for brochures, publications, and promotions geared toward engaging health plan members. Communicated benefit and health policy changes impacting plan options. Produced an award-winning campaign called the NEW You Challenge which aimed at motivating 900 electric Co-op employees to lose weight. Editor of online health plan newsletter called, Wellness & Prevention Monthly. Reengineered Life Insurance Program and increased enrollment by 25% with revenue gain exceeding $1.7M. Ensured successful marketing campaigns by writing creative briefs and projecting ROI. Creative and resourceful in developing successful projects with limited budgets by balancing the needs of internal customers with company marketing strategies. Delivered marketing collateral on message, appropriately branded and under budget. Worked collaboratively with vendors to obtain competitive bids for design and print distribution, fulfillment, and storage. Received seven (7) RE-Excellence Awards for Marketing Customer Service Event, Cancer Center of Excellence Program, NEW YOUR Challenge, New Business Outreach Program, CEO Weight-Loss Challenge, Life Insurance Program Redesign, Contracts Retention Program. Received NRECA Annual CEO Co-operative Award, Life Insurance Program Redesign. Winner 16th National Health Information Awards, Silver Winner, Total Special Health Event Program, The NEW You Challenge.

Arlington, Virginia, United States

Negotiated managed care contracts with 45 local and national PPOs and HMOs on behalf of 1000 member electric co-ops. Negotiated single-case agreements with physicians and hospitals at the local co-op markets. Collaborated with legal staff to develop a contact compendium of language. Ensured quality network access for 85,000 co-op employees and their families. Maintained strong business relationships with networks, providers, and vendors. Strove to build and find the best regional network of providers for every co-op. Established and managed contract language database. Performed vendor payment audits. Provided discount savings and network access analysis to executive management.