Company Profile: Louisiana Healthcare Connections is one of five a Healthy Louisiana plans (previously Bayou Health) and serves over 450,000 Medicaid members in Louisiana. Recently with Medicaid Expansion, many new adults whose employers were not able to +++++++ offer healthcare insurance, now are able to get coverage for preventative and primary care that best promotes health and wellness.As Senior Manager of the Provider Network in Louisiana, I manage a staff of 8 Provider Consultants and 1 Supervisor. Our department is the liaison between the providers and the health plan. As consultants to the providers in our network, we assist the Primary Care Physicians and other specialists reach their HEDIS and other quality measures. We also assist the providers in receiving prompt resolution to any issues they are encountering as well as ensuring the demographics are current in our provider directory

Company Profile: Community Health Solutions of Louisiana (CHS-LA) is a BAYOU HEALTH plan that is patient-centered and provider-driven. Our company is part of the Shared Savings model which is a Primary Care Case Management plan.As the Provider Network Manager, I coordinate communications between the Coordinated Care Network and our subcontracted practices and providers. I am responsible for overseeing the Provider Services Staff, enabling providers to receive prompt resolution of their inquiries and appropriate education about participation in the Community Health Solutions of La. network.

Company Profile: Provide independent, unbiased second opinions of diagnostic studies to the legal industry (Plaintiff and Defense).Operations: Responsible for day to day function of companyBusiness Development: Responsible for increasing existing client referrals and securing new clients.Business Office: Billing and collections in QuickBooks

Primary responsibilities included negotiating managed care contracts for a group of long term care facilities in La. Established and implemented an in-bound referral process for managed care patients. Recovered revenue for unpaid and underpaid claims. Developed and strengthened relationships between providers and referral sources such a hospital case managers and Payor case managers.

Negotiated complex managed care ancillary contracts for commercial and Medicare Advantage plans. Executed contracts within financial parameters to ensure cost effective administration of provider contracts. Established, managed and maintained relationships with providers on an on-going basis.

Negotiated new and renegotiated old managed care contracts for lines of service such as LTACs, IP Rehab Hospitals, ASCs, Imaging Centers and O/P PT clinics. Audited contracts in business offices post-implementation to ensure adherence to contracted rates. Resolved outstanding Payor claims issues. Directed Payor sales tem to increase pull-through on contracts.