Chau Rodriguez, Ms-Ha Email & Phone Number

Houston, Tx, Us

Houston, Texas, United States

• Develop provider, facility, and ancillary networks across Kelsey-Seybold’s current and expansion markets.

Houston, Texas, United States

• Develop and implement strategies to strengthen Health Plan contract performance to align with organizational strategic objectives and financial targets• Ensure the provider contracting process is conducted in accordance with departmental polies and procedures, as well as TDI and HHSC regulations• Identify, monitor, and cure network needs to ensure adequate accessibility of Members• Conduct provider network and financial analysis reports in preparation for negotiating new contracts or re-negotiation of existing contracts• Lead in project management of contracting efforts and initiatives of newly added HHSC benefits and services

Houston, Texas, United States

• Management of day-to-day processes of network development, negotiating, monitoring, and managing the contractual relationship of Provider/Vendor contracts• Project management of contract negotiations and implementations for Physicians, Hospitals, and Ancillary services• Analyze various types of quantitative data such as provider contract rates, fee schedules, utilization and claims for assessing, planning, cost containment, and contract administration• Assist leadership with translating ideas into actionable items for operations to enhance service delivery on current and new product offerings• Evaluate and monitor Provider/Ancillary networks to meet strategic growth goals and CMS network adequacy standards

Pearland, Texas

•Ensure compliance with all health plan requirements as related to the provider certification and credentialing process• Maintain and update provider communications as required by TDI, HHSC, CMS and other regulatory agencies including affiliate directories, Provider manuals, quick reference guides, and Provider orientations• Management of provider/member grievances relating to continuity and quality of care • Prepare, analyze, and present reports to various departments within the organization to improve workflow processes• Facilitate network contracting activities including coordinating provider agreements, preparing contract packages/amendments/correspondences, track and ensure credentialing process is complete, complete and load contract terms for providers in necessary databases• Negotiate and secure single case agreements with in and out of network providers and facilities• Identify and integrate strategic network providers to meet and exceed goals of network expansion

Houston, Texas Area

- Fulfillment of key role in directing subcontracts from bidding process, negotiation, scheduling, and progress- Provision of effectual support to project managers in the management and resolution of construction of quality issues during project completion- Thorough assessment of supply sources and execution of price analysis to gain most advantageous pricing- Identification and provision of solution to payment and quality issues with supply sources- Management of assessment of pricing and contract terms upon renewal and creation of strategies for negotiation

Houston

- Function effectively as project manager under the supervision of chief financial officer (CFO), responsible for contract management, price negotiation, and project bidding- Supervision to staff and daily operations of the department to ensure timely filing and development of claim through transmission- Handling of accounts receivable operation and reconciliation control to eliminate denials, late payments, reimbursement follow-up, denial resolution, customer service, cash flow, and receivables- Full accountability for all billing reports, ensuring International Classification of Diseases (ICD-9) and Health and Care Professions Council (HCPC) codes match to achieve payor’s payment criteria and medical record and authorization documentation and retrieval- Broadening of knowledge of current rules, regulations, and updates for all insurance plans and payors in adherence to Medicare, Texas Medicaid, and third-party regulations- Guaranteeing proper maintenance and accuracy of medical data for billing purposes as well as codes to generate proper billing transmissions- Ensuring alignment of payments from insurance carriers with contracted and agreed upon rates

Project Management Professional, Project Management

Master'S Degree, Health/Health Care Administration/Management

Bachelor’S; Bs, Sociology And Biology

High School Diploma