Diana Davis Email & Phone Number

Thousand Oaks, Ca

Responsible for the day to day operational support for encounter data processing and related functions including the receipt, submission, analysis and correction of such data for Medicaid Business. Responsible for the analysis of end user needs and for translating those needs into sound detail business requirements. Develops project plans and identifies and coordinates resources, involving those outside the unit. Works with programming staff to ensure requirements will be incorporated into… Show more Responsible for the day to day operational support for encounter data processing and related functions including the receipt, submission, analysis and correction of such data for Medicaid Business. Responsible for the analysis of end user needs and for translating those needs into sound detail business requirements. Develops project plans and identifies and coordinates resources, involving those outside the unit. Works with programming staff to ensure requirements will be incorporated into system design and testing. Acts as a resource to users of the software to address questions/issues.Provide direction and guidance to team members and serves as an expert for the team. Show less

Woodland Hills, Ca

Responsible for executing and delivering operational readiness plan for provider experience strategic initiatives. Monitors initiative impact to provide experience key performance indicators (KPI) and indentifies opportunities to improve KPI’s. Coordinates pre and post implementation claims audits with Inline Quality and Performance team. Oversee delivery of activities to close audit gaps. Provides subject matter expertise support for project and SSCR delivery including requirements… Show more Responsible for executing and delivering operational readiness plan for provider experience strategic initiatives. Monitors initiative impact to provide experience key performance indicators (KPI) and indentifies opportunities to improve KPI’s. Coordinates pre and post implementation claims audits with Inline Quality and Performance team. Oversee delivery of activities to close audit gaps. Provides subject matter expertise support for project and SSCR delivery including requirements contribution, solution, test case and test result review and approval, production implementation validation and support for production issues. Show less

Thousand Oaks, Ca

Responsible for serving as the liaison between Claims Operations and IT in translating complex business needs. Works with programming staff to ensure requirements will be incorporated into system design and testing. Acts as a resource to address questions/issues regarding State Sponsored Business rules and regulations and billing requirements. Provides assistance with policy interpretation. Researches, analyzes and recommends resolution for provider disputes as well as issues with billing… Show more Responsible for serving as the liaison between Claims Operations and IT in translating complex business needs. Works with programming staff to ensure requirements will be incorporated into system design and testing. Acts as a resource to address questions/issues regarding State Sponsored Business rules and regulations and billing requirements. Provides assistance with policy interpretation. Researches, analyzes and recommends resolution for provider disputes as well as issues with billing. Coordinates prompt claims resolution for Appeal and Grievance, Correspondence, Network Support and Claims department. Show less

Ventura, Ca

Collaborate with internal and external parties to facilitate Business Office and Admitting activities for both Ojai Hospital and Community Memorial Hospital. Successful implementation of Medibase Revenue Management system upgrade. Established productivity standards, developed training material and operations manual and trained staff. Provide management oversight of hospital admissions and patient business services for a 240 bed acute facility. Hire, supervise, and evaluate support staff… Show more Collaborate with internal and external parties to facilitate Business Office and Admitting activities for both Ojai Hospital and Community Memorial Hospital. Successful implementation of Medibase Revenue Management system upgrade. Established productivity standards, developed training material and operations manual and trained staff. Provide management oversight of hospital admissions and patient business services for a 240 bed acute facility. Hire, supervise, and evaluate support staff. Responsible for the administration of contracted managed care products, insurance verification, patient services, registration, billing and collections. Show less

Ventura, Ca

Identified and recruited provider contract nominations and performed contracting negotiations to maintain network adequacy.Resolved provider appeals and grievances, and claim issues while maintaining a positive relationship with provider groups and individual providers. Identified and reported on provider utilization patterns which have a direct impact on the quality of service delivery. Drafted training documents and conducted provider refresher training at onsite provider locations or by… Show more Identified and recruited provider contract nominations and performed contracting negotiations to maintain network adequacy.Resolved provider appeals and grievances, and claim issues while maintaining a positive relationship with provider groups and individual providers. Identified and reported on provider utilization patterns which have a direct impact on the quality of service delivery. Drafted training documents and conducted provider refresher training at onsite provider locations or by telephone. Researched issues that may impact future provider negotiations or jeopardize network retention. Assisted in contract compliance by obtaining information required for completion of provider contracts. Assisted providers with credentialing and provider demographic changes as appropriate. Assisted with preparation or modification of provider contracts. Show less

Greater Los Angeles Area

Managed the Customer Relations unit for a Los Angeles based MSO. Tracked customer service patterns/trends and identified training when appropriate. Responsible for the management of servicing 10 IPA and 9 hospital clients.

Greater Los Angeles Area

Performed direct physician contracting, network analysis and developed strategic plans and goals and to build and maintain a high quality contracted physician network while maintaining network adequacy.Responsible for overseeing and participating in all aspects of network development for a start up IPA.Managed recruitment projects from planning to completion, including generating formal plans and status reports.Prepared recruitment packages, including the modification and creation of all… Show more Performed direct physician contracting, network analysis and developed strategic plans and goals and to build and maintain a high quality contracted physician network while maintaining network adequacy.Responsible for overseeing and participating in all aspects of network development for a start up IPA.Managed recruitment projects from planning to completion, including generating formal plans and status reports.Prepared recruitment packages, including the modification and creation of all necessary recruitment materials, including contracts Show less

Ventura, Ca

Managed the Provider Relations staff for the Southern California division. Responded to RFPs and other requests for network development information from vendors, clients, prospects and business partners. Government program technical expert to Provider Network Management department. Interpret policy and contractual issues. Managed special projects, including contract negotiation, coordination of day to day administration of complex service issues. Provide overall guidance and consultation on… Show more Managed the Provider Relations staff for the Southern California division. Responded to RFPs and other requests for network development information from vendors, clients, prospects and business partners. Government program technical expert to Provider Network Management department. Interpret policy and contractual issues. Managed special projects, including contract negotiation, coordination of day to day administration of complex service issues. Provide overall guidance and consultation on managing the provider database. Identify the need for, develop and execute training programs for network and non-network providers. Show less