Betsy Roberts Email and Phone Number

As the Senior Provider Network Manager, Betsy establishes strong interpersonal relationships with Medical and Radiation Oncology as well as Surgical Oncology and Cardiology providers across multiple states. She is responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, and strategic providers to educate, advocate and engage as valuable partners. Betsy is accountable for managing outreach for new health plan management in her states. This includes contacting providers by email or calling to schedule virtual in-service training to ensure readiness of new portal processes. She also coordinates regularly with her providers to discuss prior authorization review and educational materials following plan guidelines. She maintains membership information integrity in accordance with HIPAA regulations. Betsy has in-depth knowledge of provider services and contracting subject matter expertise. She resolves complex provider issues that cross departmental lines and involve Senior Leadership. She works in tandem with healthcare providers and internal Utilization Management and Operations Departments.

Betsy was tasked with the opportunity to shift to Passport by Molina's liaison for Evolent Health, formally New Century Health, which manages Utilization Management for Passport by Molina's cardiology, oncology and radiation oncology providers. Betsy also focused on managing DMS (Department for Medicaid Services) complaints and inquiries for the Provider Services Department, which included provider outreach, documentation and engagement with cross-department leaders to resolve provider issues within an expedited turnaround time. The Provider Services Department relied on Betsy to manage provider outreach requests from all departments to ensure they were completed in a timely manner, as well as triaged the Provider Services Team's email inbox. Betsy collaborated with team members to create and roll out a streamlined processes for improved provider services outreach.

As the Senior Provider Network Manager, Betsy established strong interpersonal relationships with Cardiology providers across Kentucky. She was responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, and strategic providers to educate, advocate and engage as valuable partners. Betsy coordinated travel to meet regularly with Kentucky's Cardiology providers for in-services and prior authorization reviews, as well as technical edits and educational materials following plan guidelines. She maintains membership information integrity in accordance with HIPAA regulations. Betsy has in-depth knowledge of provider services and contracting subject matter expertise. She resolved complex provider issues that crossed departmental lines and involved Senior Leadership. She worked in tandem with healthcare providers and internal Utilization Management and Operations Departments.

Betsy acted as the liaison and managed the account for a provider owned Medicare Advantage Institutional Specialized Needs Plan in Kentucky. She successfully established and rolled out a new hearing aid and denture benefit. She conducted regular virtual and in person meetings with the client to ensure plan success, as well as regular meetings with providers to provide detailed information about the plan, answer any questions or resolve any issues. She researched gaps in the health plan network and recruited needed facilities and physicians, which included negotiating rates and language for hospital, physician and ancillary contracts. She prepared plan brochures and other publications for provider presentations and managed her travel schedule.

Betsy was responsible for advancing the growth of a provider owned Medicare Advantage Institutional Specialized Needs Plan in Kentucky. She managed physician contracting and network development, as well as developing, executing, and maintaining a provider network strategy. She continuously evaluated the network to ensure cost effective, optimal functionality. She supported providers from initial contract to a network application, negotiating fees schedules and language for physician and ancillary contracts. She prepared plan brochures and other publications for provider presentations and coordinated travel to meet with providers throughout the recruiting process to promote plan participation and answer questions.

Betsy was responsible for advancing the growth of multiple Medicare Advantage plans by managing all aspects of network contracting and reimbursements. She managed physician contracting and network development, as well as developing, executing, and maintaining a provider network strategy. She continuously evaluated the network to ensure cost effective, optimal functionality. She works in tandem with medical management and sales developing actions to meet market growth and medical cost targets.Betsy successfully partnered with providers in multiple states to earn Medicare adequacy. She supported providers from initial contract to a network application. She negotiated fees schedules and language for physician and ancillary contracts. She prepared plan brochures and other publications for provider presentations and coordinated travel to meet with providers throughout the recruiting process to promote plan participation and answer questionsBetsy supported and implemented strategies relating to the development and management of a provider network. She provided explanations and information to others on topics within the area of expertise, and prioritized and organized her own work to meet deadlines. She was involved in identifying and re-mediating operational shortfalls and researching and re-mediating claims. She used pertinent data and facts to identify and solve a range of problems.

As the Senior Provider Services Representative, Betsy promoted the development of a startup commercial health insurance plan by establishing strong interpersonal relationships with assigned providers. Under general supervision, she was responsible for various provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, and strategic providers to educate, advocate and engage as valuable partners.Betsy had in-depth knowledge of provider services and contracting subject matter expertise. She resolved complex provider issues that may cross departmental lines and involve Senior Leadership — served as a subject matter expert for other departments. Trained other Provider Services Representatives, as appropriate.Betsy was Responsible for provider relations in 15 Kentucky Counties, as well as the bordering counties in Ohio and Indiana. She supported the growth of provider network from 0 to over 1400 by recruiting key providers. Received special recognition for provider support and the growth of the provider network. She developed and presented educational materials to facilitate the growth of the Plan. Also Negotiated fee schedules and language for the hospital, physician, and ancillary contracts.Betsy coordinated travel to meet regularly with providers for in-services and claims reviews, as well as technical edits and educational materials following plan guidelines. She maintained membership information integrity in accordance with HIPAA regulations. She resolved complex issues by working in tandem with healthcare providers and internal Claims and Operations Departments. Collaborated with Project Management and the Claims Department to streamline the claims reporting process which resulted in claims issues being resolved quicker

As the Provider Network Analyst, Betsy was responsible for the selection, development, expansion, and contracting of provider network facilities, documenting pertinent information regarding potential provider facilities, identifying prospective providers using geographical resources, coordinating activities with fellow team members, maintaining NCQA, URAC accreditation standards; and special projects as requested.Betsy managed the development of a national ancillary provider network with a focus on Home Health, Infusion Pharmacy, Durable Medical Equipment, Orthotics and Prosthetics, and Ambulatory Infusion Suites. She grew the provider network from 100 locations to over 1800 by recruiting ancillary providers. Received special recognition for quality and customer service excellence. She negotiated rates and language for ancillary contracts and managed provider contract pricing data load, as well as any provider updates. She worked with Claims and Operations Departments to ensure that day-to-day provider needs and concerns were being addressed and responded to within a timely manner.

Betsy collaborated with IT to create reports that helped with rate negotiations, as well as streamlined the company's referral database, allowing patients to receive help sooner. She provided consultative support to all internal departments as it related to the implementation process. She conducted outreach to preferred providers received from Case Management. She worked in tandem with the Claims Department to resolve provider claims issues.

Betsy managed and streamlined the credentialing application and credentialing committee process. She researched coverage needs and conducted outreach to recruit providers nationwide. She prepared and sent all credentialing documents to potential providers, as well as confirmed that any missing credentials were received. She submitted all credentialing to the Credentialing Committee and followed up with re-credentialed every three years, maintaining NCQA, URAC accreditation standards.

As the Patient Representative, Betsy interviewed uninsured patients to determine their eligibility for Federal assistance, and supported them throughout the application process, from initial contact to their financial approval. Liaison for the patient, hospital and Medassist.