Evaluate current performance of each assigned practice; establish goals unique to each practice with a focus on STARs and gap closure; ensure all applicable groups are performing at 4 stars or higher.Evaluate practice office operations with a focus on identifying barriers to achieving targeted Outcomes. Coordinate onsite training focusing on STARs measures; (HEDIS, CAHPS, HOS, Med Adherence),Optum Programs (HQPAF, Chart Audits).Ensure all claims based issues are triaged to the appropriate party for claims analysis and resolution;Ensure timely resolution of all issues brought forth.Ensure providers understands incentive opportunities and receive ongoing feedback and report cardsDesigned to motivate and optimize provider incentive payouts.

Managed tier 1 and tier 2 providers with their HEDIS and STARs.Delivered monthly quality reports.Helped increased provider overall Annual Care Visits by 20%.Implemented quality control over non-compliant members with hiccups measures.

Interacted with providers and hospital staff to resolve claim and benefit related issues by creating an inquiry ticket, in which our research department will open and reprocess claims based on direction provided.Efficiently and accurately managed provider request for demographic information such as tax identification numbers and new addresses.  Established and fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on site enrollment opportunities for marketing.

Examined Chip and Medicaid claims and reports to ensure proper recoding of transactions and compliance with Client Company.Conducted visits to Dallas, Tarrant, Hood and Denton County Chip and Medicaid locations for education and training in the billing process.Researched and analyzed claim processing outcomes identified issues and reported as necessary.  Proactively outreached to peers, Supervisors and or providers upon findings.Provided scheduled in-services for all new contracted providers with presentation materials.  An overview of protocols and processes for Chip and Medicaid Populations.