• Supported the Contract Configuration Team under the Payment Operations Department during Go-Live through optimization periods, which included building vendor contracts, creating strategy on streamlining workflows, and teaching staff how to understand claim payment workflows.• Collaborated with interdepartmental team to perform audits during optimization period to validate that claims are processing according to contractual requirements and Texas Medicaid (TMPPM) guidelines.• Created training documentation for various testing and configuration requirements.• Working closely with the Contracts Department to improve communication and assure that claims are paying as expected.• Managed complex responsibilities, including working with key stakeholders, and ensuring deliverables were met within scope and on schedule.• Performed ad hoc analyses for the executive leadership team, particularly related to claims payment and medical spend.

• Integral member of the Go-Live team for initial implementation. Managed complex responsibilities, including working with key stakeholders, and ensuring deliverables were met within scope of project and on schedule.• Performed the configuration of vendor contracts from legacy system to new Epic implementation, which included building over 700 vendor contracts with over 3,000 providers in the managed care network. • Conducted analysis of legacy data to compare against business build requirements.• Led meetings with business owners to fulfill the organizational requirements.• Conducted and oversaw configuration requests submitted through SharePoint ticketing system, CRM, Sherlock (Epic) and ServiceDesk Plus. • Performed ad hoc analyses for the executive leadership team, particularly related to medical spend and AP Claims.• Responsible for building and maintaining contracts that configuration for reimbursement, fee schedules, case rates, per diems, DME (Durable Medical Equipment) which includes vendor contracts which apply to Shared Risk and Global Risk contracts. • Proficient in reading and understanding contracts language and skilled in translating to configuration requirements to meet claim pricing expectations.• Key members of business and IT workgroups with Claims, Triplets, Claim/Vendor Issues Workgroup, Fee Schedule & Contracts Workgroups, Huddles, and ad hoc meetings.• Gathers, designs, and develops detailed specifications incorporating business and technical requirements to support Managed Care business model.• Builds detailed specifications for Epic Tapestry, and prepares product for testing environment. Analyzes, maps, and documents current and future work flows. • Provides application/system support by answering questions and resolving problems/issues from end-users/business owners. Interface with vendors as necessary to answer, resolve or correct problems/issues.• Support Pre & Post go-live production deployment.

Responsible for contracting and building the Brown & Toland Physicians provider network , including being responsible for the managing primary and specialty care physician’s contracts, various physician groups, and ancillary arrangements. As a Contracts Manager, I was responsible for the following areas:• Responsible for the negotiation and management of new contracts and amendments for both physician and ancillary providers. Provided oversight to HMO network of over 2,400 physicians and 500 ancillary providers. • Performs analyses for CMS network adequacy through use of Quest Analytics. • Conducts analyses, including utilization and financial performance, of provider contracts.• Develops strong relationships throughout Brown & Toland Physicians and have successfully gained the confidence from various internal departments. Became the subject matter expert for Network Contracting regard contract system set-up and claims payments processes.• Actively works with external vendors and providers to resolve questions and/or concerns.• Submits tickets to add new providers to network, for use by Medical Services, Provider Services, and Claims. • Provides technical support to company-wide projects, including GE/AllScripts System Updates, system-wide Go Lives, Vistar/eVIPs Implementation, and Network Expansion.• Conducts the negotiation and implementation of single-case and ongoing letters of agreement. • Created and implemented a SharePoint Tracking system to be used for contract statuses, running queries, and providing reports. • Trained and supports Contract Specialists regarding Letters of Agreements, Ancillary Grids, and GE/IDX system wide updates.• Created and maintained various grids including Health Plan, Brown & Toland Health Services, IPA, and Letters of Agreement.

Responsible for supporting Brown & Toland Physicians network contracting efforts, including being responsible for the managing primary and specialty care physician’s contracts, various physician groups, and ancillary arrangements. As a Contract Specialist, I am responsible for the following areas:• Oversees the development and implementation of single case and ongoing letters of agreement. • Conducts contract analyses and contributed to operational implementation. Assists the Contract Managers, the Director of Network Management, the VP of Compliance and the COO with reports, as needed and requested.• Conducts reviews of contracts for financial performance and utilizations of the provider contracts. Solicits information and feedback from other operating departments, as needed, to create and present effective reports.• Creates and maintains and various grids including Health Plan, Brown & Toland Health Services, IPA, and Letters of Agreement.• Ensures timely filing of executed contracts into internal contract database, as well as filing hard copies. • Created a Microsoft Access Database, from scratch, to be used for tracking, running queries, reporting, and storage of physician and ancillary provider’s contracts. • Submits tickets to add new providers to network, for use by Medical Services, Provider Services, and Claims. • Administers and creates documents and mailings to providers.• Attend and take minutes to various internal meetings. In addition the tasks listed above, I have also excelled at developing strong relationships throughout Brown & Toland Physicians. I have gained the confidence of internal teams, including Payor Contracting, Provider Relations, Claims, Medical Services, Compliance, Credentialing, Business Application Configuration and IT. I also actively work with external vendors and providers to resolve questions and/or concerns.

• Accurately and promptly process re-credentialing applications in accordance to the organizational policies and procedures, health plan delegation requirements, and NCQA standards. Prepare credentialing files and monthly tracking material to be used in the credentialing committee meeting. • Respond to requests from internal departments and external customers, including providers and medical offices. • Create and maintain files and filing system for health care professionals participating under group agreements. Verify credentials and complete processes to comply with Brown & Toland’s internal credentialing standards.

• Provide customer support and real-time assistance to the Lyft community by helping build the platform throughout San Francisco as a community driver. Maintain a consistent average rating of 4.9 (or higher) out of 5-star rating while working with over 4,000 customers. • Trained 95 (and growing) new drivers who joined Lyft and provided real-time, on-going support. • Recruited over 105 new drivers (and growing) by interviewing, responding to inquiries, evaluating and recommending to appropriate steps of joining Lyft.• Promote the growth of Lyft through personal marketing, events, and social media platforms.

• Conducted a performance review for an IT department within a large healthcare organization based on results from the internal customers. Evaluated results to provide a detailed analysis of performance levels within the individual and cross-functional areas, created a consolidated report and presentation for review by IT Directors, and provided recommendations for changes to future methodology and historical analysis of the performance review.• Redesigned dashboard for the IT department applications availability status for a large healthcare organization and provided procedure manual to analyst.• Provided synopsis for Meaningful Use Stage 3 to providers at a large hospital for use during open comment period.

• Mentored and trained over 14 chapter and coalitions coordinators on the development of Safe Kids program by conducting bi-monthly statewide meetings, planning and organizing annual educational retreats, and providing ongoing administrative support.• Executed an inaugural regional conference, which included six surrounding states with over 100 local participants, and representatives from Safe Kids USA, the national headquarters. Acquired sponsorship funding and secured speakers from a variety of disciplines to present at the conference.• Analyzed data sets from mortality reports, emergency room visits, and hospital stays to understand unintentional injury rates in Utah. Accomplished a 14% decrease, statewide, of unintentional deaths, a 6% decrease in hospitalizations, and a 5% decrease in emergency room visits of children ages 0-14 from 2008 to 2010. • Conducted over 80 media interviews, including television, radio, and newspapers; organized and carried out seven press events; and submitted quarterly press releases. Redesigned the Safe Kids Utah website, twitter account, and Facebook page.

• Developed operational strategies to increase patient quality of care based on quarterly results from Patient Perceptions of Quality Survey Reports administered corporate-wide.• Worked directly with the practice manager to increase clinics from three clinical sites to five clinical sites. Provided administrative support for human resources, operational support, employee orientation, marketing, and physician support.• Created and distributed monthly financial reports for OSG surgeons, and evaluated and resolved discrepancies in monthly expenses.

• Streamlined process of tracking physician enrollment by proposing and implementing a new credentialing software, OneApp Pro Credentialing Software, to be used by PMG, Inc.’s clients.• Simplified the credentialing process to effectively track the enrollment process and ongoing professional documentation of 125 physicians to over 265 physicians and 25 CRNA’s.

• Designed graphics and pages for the only bi-weekly, bi-lingual English/Spanish newspaper in Idaho.