Brandon Roach Email & Phone Number

Dayton, Oh, Us

• Perform gap analysis to ensure no gaps or sanctions while identifying and implementing solutions that mitigate risks then develop corrective action plans as needed• Implement an effective process to on-board new providers, ensure network is adequate (access for members to initiate set-up and ensuring provider contracts are input into the system according to corporate compliance)• Follow up with Health Partners to resolve any routine issues in the market utilizing department’s service level agreements/ expectations• Execute the contracting strategy, develop provisions based on cost, quality/ analysis and monitor key metrics for the assigned market• Responsible for provider recruitment, administering provider contracts, terms, reimbursement rates, and overseeing specialists• Create contract language and review with legal team to develop approved contract templates specific to the assigned Market/ Maintain PR Customer Relationship Management • Support the account strategy and provide account support with the goal of driving the overall satisfaction and engagement of Key Health Partners

Saint Louis, Mo, Us

• Served as the primary contact for providers and liaison by providing education on health plans with innovative contracting strategiesProvided coaching and strategic overview to provider groups, on different ways to capture key HEDIS measure assigned to their patient panel. This was done through utilizing various VBR resources. • Performed educational overview with staff and also conducted provider orientations as needed. Provided continual on ongoing provider education with different groups, which included: writing and updating new and current orientation materials, reviewing any new and updated changes with state and federal policies and guideline, reviewing contractual guidelines and making sure those agreements are being followed properly. • Conducted monthly face to face meetings with the provider account representative documenting discussions, issues, attendees, action items, and research claims issues on-site, and routed to the appropriate party for resolution• Received, investigated, resolved, and communicated provider claim issues and changes• Completed data entry of provider-related demographic information changes and oversaw testing and completion of change requests for the network• Educated providers regarding policies and procedures related the referrals and claim submission, website usage, EDI solicitation, and related topics

Saint Louis, Mo, Us

Act as a liaison between network providers and the health plan, investigating various issues and resolving them in a timely matter. Perform provider trainings as needed, along with provider network performance analysis and product optimization. Also responsible for contract negotiation and implementation activities, including but not limited to recruitment and product implementation with in assigned networks. Also works with internal cross functional teams, on various organizational projects and request that support provider relations and the health plan.• Serve as primary contact for providers in assigned markets, serving as a liaison between providers and the health plan.• Communicates all issues regarding provider related concerns, with internally leaderships while also resolving those issues.• Provide strategic and operational leadership, while staying focused on network performance goals and quality metrics.• Acts as data steward for provider data metrics, and provider network strategies to improve network performance. • Partners with operational leaders to identify and prioritize meaningful opportunities for network improvement.• Supports implementation of processes and programs for new risk and rewards arrangements for providers.• Educate providers on policies and procedures relating to referrals, claims, and authorization submissions via provider Portal. Provide portal education, EDI solicitation, and HEDIS performance to providers (liaison responsibilities)• Effectively communicate responsibilities with peers and cross functional teams, while collaborating on various departmental projects that support Provider Relations.

Saint Louis, Mo, Us

Assist the health plan in establishing a presence in the community through home visits and community outreach imitative programs. The Primary focus in this position is to ensure that members are utilizing all the resources they have available with their health care provider, while making sure HEDIS measures are being reviewed and implemented with in the network population. • Market the health plan by establishing a strong community presence, through community outreach events and member educational opportunities.• Educate members on healthcare benefits and identifying accessing care Gaps and solutions.• Perform home visits to members for care management noncompliance and benefit utilization education. • Assisted in connecting members to community agencies, and Local community health department resources•Coordinate and implement community events, including Start Smart Baby showers and Birthday Parties, school events, healthy life style events and various community initiatives•Schedule and complete home visits for noncompliance, benefits information, ED and readmission diversion and other high risk issues•Conduct targeted phone calls for compliance, HEDIS initiatives and health risk assessments• Works in partnership with internal department leaders on special projects relating to community outreach and quality improve.

Assisted in coordinating and developing marketing support for the 2012 Cleveland Classic.Assisted the Cleveland Sports Commission in helping find and secure sponsorship funds for the 2012 Cleveland Classic.Determined quality assurance issues through interacting with managers, team members and clients to ensure that all goals and standards are being met with above and beyond satisfactory levels, while still maintaining a positive attitude.Establish new strategies to increase revenue profits while lowering overhead cost and increasing production of services.Demonstrated strong strategic planning processing skills, with a focus on maximizing marketing goals and revenue bench marks by expanding on analytical findings of customer sales and marketing evolutionary trends. Improved overall profit margins and marketing goals.Assisted in increasing media endorsement traffic and consumer awareness, to utilize untapped markets for new consumers while continuing to monitor the current media trends of existing consumers.

Perform community outreach to various venues for ACA education to communities during open enrolment period.Track all community outreach contacts and ACA impact rate for Cleveland Team via excel, Google docs, and email communication correspondents.Compile and analyze daily productivity data in order to measure the penetration rate at each site.Provide accurate education on the Affordable Care Act (ACA).Perform advisory presentations and Q&A sessions regarding the ACA and enrollment process. Provide consumer assistance during the healthcare enrollment process via the Marketplace.

Valley View, Oh, Us

Received calls from Vendors in an effort to provide on-site approvals for work per HUD guidelines through bid cost estimating softwareConducted negotiations with vendors to ensure that work on selected properties was completed in a timely manner. Reviewed current and past loan histories, documented information of various REO properties by using estimating software and Microsoft Office applications in accordance to Federal and Regional Property Preservation Guidelines.Independently made decisions for vendors work needed based on various bid amounts and submitted to HUD for approval, and followed up with customers and respond promptly to inquiries. Worked under productivity and quality standards set forth by the department, and made sure standards were maintained.

Coordinated all necessary medical health care issues, while providing support to all clients helping them develop productive treatment plans for their personal success and mental well being.Provided counseling and therapeutic intervention support to 60+ clients facing issues with their treatment plan goals.Worked with clients who where mentally disabled and assisted them with maintaining their treatment plan goals.Data entry experience in processing client review notes within 72 hour time frame

Bannockburn, Illinois, Us

Understanding of procedures and protocol when dealing with Biohazards waste materials and the proper disposal of Hazardous waste products based on FDA and HIPPA regulations.Acted as a liaison and educator to Nurses and Doctors about how to properly dispose of Medical waste products, and how these procedures relate to HIPPA and FDA Guidelines. Provided onsite training and education of the correct disposal procedures.Provided constant education to patients and families on medical disposal procedures, by providing demonstrations and distributing literature on proper Medical waste disposal.Maintained positive relationship with clients on service needs through reviewing data implementation on products and education on management reports through presentations and personal meetings.

Quality Control experience in dealing with products and services relating to industrial swimming pool materials and blueprints.Ability to maintain a diverse work schedule traveling to multiple locations, and communicating with various staff and clients about company products and services.Great attention to detail along with people soft skills to be able to review issues and resolutions on quality matters with clients, as it relates to products and services. Strong analytical and problem solving skills when dealing with issues relating to the development of pool.

B.A. Communications, Business Administration And Management, General

Associate'S Degree, Business Administration And Management, General

High School

Education record