Darin Yates Email & Phone Number

Kalamazoo, Mi, Us

Kalamazoo, Michigan, United States

• Performs health plan provider orientations and conducts ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network.• Acts as liaison between providers and the health plan to enhance the business relationship and ensures a coordinated effort in improving financial and quality performance.• Educates providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, website education, EHR, Health Information Exchange, and EDI.• Enhances account relationships by investigating, documenting and resolving provider matters, and effectively handles and responds to account changes and correspondence.• Provides information and status updates for providers regarding incentive agreements.• Creates and communicates milestone documents, dashboards and success or improvement metrics.• Engages providers and educates them on Patient Centered Medical Home initiatives.• Performs detailed Health Benefits Ratio analyses, HEDIS, and creates reports for provider review performance by both quantitative metrics and qualitative factors.

Kalamazoo, Michigan, United States

• Primary coordination lead for engagement management initiatives including working with external providers on appropriate use of the network, adoption of interoperability technology, self-service adoption, affordability targets and overall education.• Provide day-to-day management of engagement activities, including project management, reporting, coaching, implementation, problem resolution with defined service partners and other activities to assist in the facilitation of a successful relationship with assigned providers.• Develop and execute a strategy for each provider identifying both provider and company objectives and ensuring optimal utilization of interoperability services.• Analyze provider and health system operational, quality, and financial performance as it relates to the interoperability initiative. • Interface with key individuals from provider practices to drive understanding of the provider practice data, act as a subject matter expert and support needed practice workflow changes.• Ensure practice data is shared at specified intervals so providers understand how they are performing on a timely basis and can improve their performance to set benchmarks.• Presents practice data and information at external meetings to ensure tools maximize value and collaborative efforts are completed.

Kalamazoo, Michigan, United States

• Assisted in resolving provider claims/issues and addressed concerns.• Assisted in efforts to enhance ease of use of physician portal and enhancements.• Contributed to design and implementation of programs that built positive relationships between the health plan, providers, and practice managers.• Supported development and management of provider networks.• Helped to implement training and development of external providers through education programs.

• Participated in negotiating contracts with provider groups for network growth. Contributed to and expertly oversaw departmental initiatives by serving as project manager.• Functioned as primary point of contact for providers and managed all activities for establishing and sustaining productive relationships with existing managed Medicaid network providers.• Kept track of provider issues and concerns; formulated solutions and made recommendations; and regulated coordination for resolving issues.• Conducted evaluation of provider network to ensure adequacy in addressing medical needs of members, while taking part in the identification and recruitment of key providers with network gaps.• Rendered utmost support for the training and mentoring of provider relations representatives to ensure departmental success.

• Acted as a liaison between system provider groups and contracted delegated managed care plans; carried out strategic efforts to ensure positive relationships for all parties.• Led the creation, collection, and updating of information necessary to support the network development process.

• Assumed full accountability in managing, servicing, and expanding existing provider network within established territory, while securing and developing new business among non-participating providers. Played a key role in surpassing provider additions and retention goals, which resulted in consistent growth and increased provider participation by more than 15%, with sustained provider retention rate of over 99.5%.• Ensured constant communication with all providers while serving as the only outside sales and service representative throughout the territory.