Cornelia Harvey Email & Phone Number

United States

Remote

• Network development for VA Disability.
• Recruitment and contracting of providers.

Telecommute

• Network development for TriWest
• Recruitment and contracting of providers and groups for deficiencies
• Utilizes Zoho to initiate, execute, and deliver rosters for contractual deals

• Served as a plan liaison to assigned counties of contracted and out of network providers in order to assure effective communications, prompt problem identification and solutions, as well as maintenance of consistency.
• Recruited, contracted, and developed three counties in New Jersey for Medicare, Medicaid, and DSNP
• Negotiated reimbursement fee schedules to meet the expectation of target groups/providers
• Identified risk factors for contracts
• Created and monitored the 30 largest physician groups in network and other business correspondence
• Answered and resolved provider calls, complaints, policies and procedures, network participation, and claims

Bronx, NY

• Identified network gaps and implemented new business strategies through physician recruitment, enhancing provider network for both hospitals and providers
• Conducted recruitment, contract negotiations, and education for Medicare, Medicaid, and Ancillary lines of business
• Claims analysis for FFS vs CAP providers
• Implemented new systems

• Educated provider community on company policies, contractual obligations, and billing guidelines for all lines of business
• Conducted recruitment, contract negotiations, educations, and contract for assigned territories
• Performed claims analysis, appeals, and reports