Bethany Carter Email & Phone Number

Greensboro, Nc, Us

Greensboro, North Carolina

• Direct oversight of Medicare Advantage Provider & Network Services, Part C Claims, and Appeals, and Grievances departments• Supports contracting strategies and reimbursement initiatives by working directly with contracting to support Plan’s financial performance.• Created and staffed Plan’s Provider Services department to deliver all provider call center support (including claims), onboarding, education and trainings, network materials and Quality and RAF support.• Responsible for providing oversight and leadership regarding direction, policy and procedure, and compliance with CMS requirements related to all areas of transactional processing including claims, provider services, appeals, and grievances• Manage TPA Operations including configuration (provider contracts, network loads and benefits) and claims.• Provides strategic leadership to Plan staff• Active participant in internal and CMS audit preparation and presentation• Monitors, evaluates, and implements workflows and operational processes of various departments to improve efficiencies• Partners with vendors, delegated entities, and providers to effectively manage the Plans benefits and network• Serves as voting member of Network Development Committee/Provider Oversight Committee, Medical Management Committee, Policy Governance Committee, and Joint Compliance Committee

Greensboro/Winston-Salem, North Carolina Area

Greensboro, North Carolina

Greensboro/Winston-Salem, North Carolina Area

• Responsible for the establishment and ongoing management of relationships with Triad HealthCare Network (“THN”) providers and their office staff as well as vendors and payers regarding the implementation and usage of THN resources deployed to advance THN quality and clinical integration initiatives to maximize the Network performance according to the terms of the value base contracts with CMS and Payors.• Responsible for providing support and assistance to THN and THN providers to achieve targets outlined in established incentive programs in addition to the achievement of recognition and/or designation from national accrediting bodies (NCQA, Bridges to Excellence, etc.), THN contracted insurance companies, or other respective entities for accomplishments of disease management, population health management, medical cost management and adoption of Patient-Centered Medical Home (PCMH) principles. Assisted with the determination of necessary provider recruitment, onboarding, and initial education to ensure network adequacy.• Coordinated the implementation, training, support, and ongoing maintenance of all such THN resources as well as the tracking and reporting of the usage of these resources.• Served THN providers and their staff with contracted payer claims resolution and provided management and support of divisional meetings to report and review quality and cost utilization performance.

Greensboro, Nc

Key responsibility is to provide leadership and management of the practices 24 employees with 5 physicians, 3 advanced practice providers, and a patient base of over 10,000. Human resource roles include: staff management and meetings, provider call schedules, training, disciplinary and grievance, performance reviews, contract negotiations, payroll and benefit package maintenance. Information technology responsibilities involve monitoring and maintaining all practice hardware and software, programming super user, maintaining patient records, data management, security; responsible for hardware support, crisis management and project management. Practice development roles include supporting clinical staff to achieve clinical effectiveness, and professional development. Focus on strategic input for long term business planning and growth, and marketing.Premises and management of supplies, equipment and facilities including ongoing maintenance, security, project management.Risk management responsibilities include health and safety, privacy, fire safety, disaster planning,complaints, infection control, confidentiality, and information governance.Finance management focus including bank reconciliation, daily accounting, petty cash, salaries, draws, planning, and claims/coding and billing compliance. Responsible for contract negotiations and supervising all accounts payable and receivables.

Efficiently handle all accounts payable and receivable transactions for two golf shops averaging gross annual sales of $350,000. Oversee golf daily charge activities for the area’s most prestigious club with a membership base of 1,400. Track all golf activities for two award-winning courses with average annual rounds of 250,000 and round revenue of over $3 million annually. Serve as a direct liaison between the Director of Golf, club staff and various club committees with on-time and precise monthly reporting and completion of special projects.

Responsible for all P&L management, business plan, annual operating budget, and human resources. Primary daily and weekly activities consisted of all accounts receivable, accounts payable, and payroll for a business maintaining an average annual sales of $600,000 and a lifetime sales of over $3,500,000. Supported building a strong, recognizable regional franchise brand and execution of an exit strategy three years ahead of initial goal.

Managed all accounts payable and receivables, and related staff for this unique 10+ provider, three-site pediatric practice. Served as liaison between GCH and it’s partners: Guilford County Health Department, Moses Cone Health System, High Point Regional Health System and the Pediatric Teaching Program at MCHS. Worked closely with Executive Director to implement cost controls, revenue enhancements and systems aimed at operational stability.

Successfully maintained the highest call volume and service satisfaction in provider assistance for each month of employment. Services included provider education on claim submission procedures, policy benefits, and assistance in claim review and dispute procedures. Earned the unique opportunity to cross assist the department with state-wide, on-site visits to support provider relations in staff training, package roll-outs and compliance.

Mha, Masters In Health Care Administration

Mba, Master Of Business Administration

Ba, Psychology, Cum Laude

Activities and Societies: President and Member, Beta Beta Beta (Biology Honor Society), Member, Omicron Delta Kappa (Leadership Honor.