Focus is on IPAs performance in West Florida -

Provider recruitment and implementation of contracts for new market and expansion of existing markets.

Lead a team of Network Specialists to educate providers on claims submission, Health Information Exchange, and on Patient Centered Medical Home initiatives.Perform detailed medical loss ratio (MLR) analyses, HEDIS analyses and create reports for provider performance by both quantitative metrics and qualitative factors.Conduct initial provider orientations as well as ongoing educational outreach. Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance.

Managed and coordinated account service activities for a book of business with over 2,000 enrolled subscribers in the Large Group Public Entities sector. Managed account renewals, customized benefit designs and collaborated with actuarial and underwriting for pricing.• Client presentations on medical, dental, and vision plans

Managed a team of Network Specialists to service the commercial HMO contracts and Medicare Advantage plans of 150 participating medical groups, and 26,000 contracted physicians. Demonstrated the ability to communicate persuasively and effectively to a wide range of internal and external customers to ensure compliance with the terms and conditions of contracts, rules and regulations and resolve complex issues.

• Managed and coordinated all service activities and contractual requirements for the administrative contract of the Managed Risk Medical Insurance Program (MRMIP). • Assisted with the development and implementation of the Healthy Families Program, Access for Infants and Mothers (AIM) Program, and Medicaid.

• Customer service, claims, membership functions