Carol Johnson Email & Phone Number

Chicago, Illinois, Us

Recruit individual physicians, ancillary providers and facilities for participation in the Health Exchange and Medicare Advantage network. Gather provider and facility credentialing documents.Negotiate Market competitive contracts in key areas to meet regulatory needsResearch and recruit specific provider types to enhance member experienceRenegotiate provider contracts at lower rate resulting in unit cost reduction.Identify service issues and collaborate with cross functional team to implement improvement process. Facilitate meeting with providers and internal staff to address service issues and improve working relationship

Contact providers regarding education and participation in Multiplan Workman’s Compensation program.Educate providers about Multiplan and their ever-expanding portfolio of products and services, ensuring continually updated knowledge about Multiplan.Ensures providers receive appropriate education regarding Multiplan’s processes and protocols.Documents all activities accurately within the database/portal.Adheres to all regulatory requirements; comprehends and complies with best practices, professional standards, internal policies, and procedures.Works in collaboration with cross-functional teams to identify trends and assists in developing strategies to enhance client satisfaction and drive growth and expanded business for Multiplan.Identifies service issue trends and collaborates with cross-functional teams to develop and implement improvement plans.Monitors provider concerns and issues and provides feedback to the appropriate associates/departments.

Hartford, Connecticut, Us

•Performed trusted network analysis for a large national account with over 400,000 insurance subscribers•Implemented customer-specific network strategies to optimize customer network opportunities•Identified, analyzed and developed cost saving opportunities •Participated in national internal healthcare initiatives•Worked cross-functionally with Network Management. Clinical and Analytic Consultants to review medical cost trend drivers •Participated in customer meetings to present quarterly results and solutions

Hartford, Connecticut, Us

•Utilized emerging trends research to negotiate complex, competitive contracts with providers over $2 million profile •Assessed provider networks and collaborated cross functionally to eliminate network deficiencies•Resolved highly complex issues related to claims payment, contract interpretation, policy and procedure development•Executed provider compensation/reimbursement and pricing development activities •Identified, analyzed, and managed medical costs and initiated appropriate actions •Spearheaded Joint Operations Committee meeting for high profile providers •Supported sales and market growth, community relations and guidance with comprehension of applicable federal and state regulations

Hartford, Connecticut, Us

•Managed all aspects of ancillary and physicians contracting •Executed negotiations in support of network quality, availability and financial goals •Assisted with the design, development and or implementation of strategic network configurations and integration activities•Drove network maintenance and refinement activities and strategies in support of cross-market network management units •Improved cost arrangements within specific provider groups groups