Dexter Hall Email & Phone Number

Inglewood, Ca

Marina Del Rey, California, United States

United States

Inglewood, California

Greater Los Angeles Area

Benefits consultant

Develop and implement provider network and contract strategies, identifying specialties in which to concentrate resources for establishing a network of participating providers. Partner with stakeholders in the network development process to achieve maximum team effectiveness Manage clinic operations including staffing, training, HIPAA compliance, inventory, scheduling, medical records mgmt, cost containment and health plan activity. Implement policies and procedures to ensure member satisfaction and facilitate enrollment growthConduct fee schedule and rate analysis to assure that all fee schedule and/or rates under review achieve the goals and targets for reimbursement that meet the expectations of the payor and the health care provider represented during the reviewNegotiate reimbursement rates & contract terms, obtaining the best possible terms in the market. Execute audit processes to identify non-standard terms, and identify the contracts that meet established performance criteria & those that were in need of remediationDevelop & maintain a provider network (i.e. physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) through contract negotiations and relationship development. Contracts include non-standard and standard termsLead the design, development & implementation of automated reporting mechanisms that are specifically focused on unit cost performance of Provider Network Management. Develop lead the re-engineering of Provider Network Mgmt processesDirect all billing & collection procedures including appropriate coding & ensuring that staff is trained & educated in all govt medical coding & billing requirements. Prepare for changes impacted by billing/collection procedures & government regulationsOversee daily call center operations, ensuring efficient work flow & quality service. Coached call center associates on policies & procedures related to the center & other units within the organization. Comply w- regulatory requirements

Master'S Degree, Health/Health Care Administration/Management

Bachelor'S Degree (Cum Laude), Health Education