Manage E2E processing of contracts and relationships of over 3000+ Physcians/Medical GroupsManaged Facility Healthcare systems in Manhattan and Bronx territories including Mt Sinai, New York Presbyterian, Columbia and Cornel Docs, Montefiore medical Center, Essen Medical.

Manage a team including oversight of Claims Examiners.Facilitate meetings between Healthfirst and providers while managing multiple claims projects through resolution.Develops a strategic business plan for Providers while effectively utilizing internal and external subject matter expertise in the development and delivery of creative solutions in the meeting of their business goals.Maintain relationships with key ancillary, physician, hospital, and integrated delivery systems..Monitored metrics and benchmarks around the provider experience, and engage appropriate associates to turn around negative trends.Develop and formalize routine contacts with key internal and external departments and managers, to improve communication, share strategic plans and coordinate efforts between departments in order to achieve department & corporate goals.Facilitate reprocessing of all identified claims while working with internal teams to perform root-cause analysis.

Manage relationships with key hospitals and providers while analyzing the ancillary provider network for adequacy. Monitor organization productivity, hospital revenues, expenses, and contractual allowances as compared with targets.Responsible for reviewing non-compliant facility claims with American Medical Association (AMA) industry standards relating to ICD-9, CPT-4 and HCPCS coding guidelines. Reconciled hospital accounts while identifying pricing issues and billing discrepancies.