Debra Spaulding Email & Phone Number

Syracuse, New York Area

New York

Network Development and Provider Relations for Medicaid Managed Long Term Healthcare Plan

North Syracuse, Ny

• Developed provider network comprised of four hospitals and over 500 primary care and specialty physicians in Onondaga County• Managed and maintained contractual relationships with provider network

East Syracuse, Ny

• Developed detailed financial models used for hospital and facility contract negotiations • Negotiated, managed, and maintained contractual relationships with over 75 hospitals and facility- based providers throughout New York State and surrounding region• Managed hospitals and facilities in all matters related to contract disputes and all contract implementations• Independently interacted with Legal Department on contract preparation and resolution of issues raised by facilities and providers

Syracuse, New York

• Mined data from hospital information system, data warehouse, and NYS SPARCS to create reports used for managed care contracting activities • Analyzed payer contract performance and revenue to identify operational and/or contractual deficiencies and suggested changes to maximize reimbursement• Programmed and maintained back-end contract management system, ensuring reimbursement terms accurately reflected terms detailed in contracts• Researched and analyzed regional demographics, hospital trends, and competition as it related to University Hospital’s market share • Used knowledge of a variety of fee sources and billing guidelines to educate ancillary, clinic and emergency services staff on proper billing for services. Fee sources and guidelines included: CMS Outpatient Prospective Payment System, CMS National Physicians Fee Schedule (RBRVS), CMS Clinical Laboratory Fee Schedule, CMS Ambulatory Surgical Center, and State Medicaid • Coordinated changes to the Charge Description Master • Assisted hospital administrators in determining appropriate charge structure for ancillary, clinic, ambulatory surgery, and emergency services• Determined system requirements for billing software application upgrade

Master Of Science (M.S.), Education

Bachelor Of Arts (B.A.), Communication Disorders