Debbie Terry, Mba Email & Phone Number

New York, Ny, Us

• Build and sustain collaborative relationships with providers to achieve value-based performance goals• Work cross organizationally to ensure successful implementation of provider programs and agreements• Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership• Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data • Create strategies to improve key performance indicators, analyze performance data and identify opportunities and improve outcomes

Newark, Nj, Us

Newark, Nj, Us

Build and maintain effective relationships with all facets of the provider community, providing education, through ongoing relationship management, webinars and seminars.Facilitation and resolution of complex issues in the area of claims management, compliance and complaint resolution.Utilization management through profiling data and referral patterns to maintain and track cost savings opportunities for our 3.2 million members at NJ’s largest health provider.

Jacksonville, Fl, Us

Manage a team of seven provider relations associates.Coordinate the activities and projects of the team in an efficient manner.Train provider relations associates in the areas of relationship management, compliance and complaint resolution Perform site visits in concert with Network Development Team.Responsible for the review and update of the Provider Manual, creating needed communications on updates, changes and required information to a national network of contracted providers.Collaborated with Customer Service, Call Center, Claims, Contracting, and Credentialing Department to improve issues relating to process flow and delineation of duties as it relates to resolving issues, complaints and root cause analysis.

Provided support to the provider relations management team, implementing processes and lead on projects.Managed relationships with key medical groups, hospitals and providers.Analyzed performance of assigned provider network in terms of utilization, cost per unit, quality of care and patient satisfaction.Acted as an internal liaison to key provider organizations and individual providers to ensure complex issues are responded to and resolved in a timely manner.Negotiated individual and group contracts.Investigated and recruit providers needed, soliciting them via office visits, telephone and mail.Interacted with affiliated department to ensure closure of work flow.Identified and corrected data discrepancies, perform data maintenance request to correct, add and terminate provider record.Collected and verified provider credentials, conducting primary sourcing.

Provided frontline service to providers, members and facilities via customer call center.Verified plan eligibility and quoted member benefitsResolved medical/dental/vision claim issues on all product lines.Assigned care management cases to the NCM for medical necessity review.

Performed initial review of service requests, collected and organized non clinical data.Entered demographic data and other pertinent information into the computer system.Precertified non challenged procedures.Answered telephone calls from medical management nurses call queue on medical case management department related issues.Assigned care management cases to the medical case management nurse for medical necessity review.

Master Of Business Administration - Mba, Health/Health Care Administration/Management

Bachelors Of Science, Healthcare Management