Edward Vandermark Email & Phone Number

Lexington, Nc, Us

New York, New York, Us

Miami, Florida, Us

As Payor Contracting & Credentialing Manager, I oversaw all contracting and credentialing efforts for a multi-state Behavioral Health practice. Provide direction to staff in order to ensure that providers are credentialed and enrolled in plans quickly to ensure patients have qualified clinicians to assist with their behavioral health needs.Always seeking out opportunities to challenge the status-quo of contracting and credentialing to find and implement new operational standards to create efficiency with production and costs.Additional responsibilities include: business development, product innovation, strategic planning, contract negotiations, project management, needs assessment, market analysis, operations management, relationship cultivation, and client management.

Walnut Creek, Ca, Us

Paradigm is the industry leader in solving complex health care challenges and improving lives for injured workers. For almost 30 years, we've set the standard for outcomes-focused care of workers' compensation cases involving the most challenging catastrophic injuries.As a Director of Network Management, I work directly with healthcare providers so they can join our provider network to help care for our members. I strive to ensure that our providers and our enterprise find the best fit with terms and rates in our agreements. Establishing a good relationships with our providers is my main goal so that are providers are happy with the service we bring them and are comfortable to come to me if they ever have questions or concerns.Furthermore, I built the CRM utilized by the department with Salesforce. Created the platform using custom fields and layouts to ensure an easily operational flow for the front-end user to collect data and log their activity and interactions with our providers. To ensure data integrity, validation rules were implemented and then used workflows and process builder to eliminate steps our team had to take. Automated processes include standardized interdepartmental communications to keep other departments immediately updated on provider enrollment and to send automated email templates to providers who haven't responded to enrollment requests.

• Daily Operations of assigned Subrogation clients:a. Designed and implemented policies, procedures, and workflow processes to assure quality productivity from front line staff.b. Brought clients into compliance within first year using right-fit staffing and by training Team Leads appropriately.• Created company-wide Diversity program:a. Worked with Human Resources, company leaders and the Executive Team to create an employee network resource group model to recognize and celebrate diversity throughout the corporation and for community outreach opportunities.b. Individualized ENRGs formed for African-American, LGBTQ, Professional Women, Asian/Island Pacific, and Hispanic demographics.

Louisville, Kentucky, Us

• Daily Operations of the Provider Network Operations for the American Eldercare product line: a. Recruited appropriate staff based on inventory needs, including any upcoming projects/expansions. b. Built and/or revised departmental policies and procedures to reduce provider onboarding time from a nine month turnaround to a 1 week turnaround.• Maintained inventory by putting in place proper controls: a. Created automated reports to identify current inventory and reduced a 2,000 provider backlog in Credentialing in 8 months. b. Worked with department leaders to identify recruitment, training, and/or technology changes for network expansion.• Ensured department was always in compliance with NCQA and CMS standards: a. Elected Chairperson of Credentialing Committee and Board of Directors member for Quality Improvement Committee to ensure adherence to compliance. b. Assisted in information gather for both internal and external plan audits and always received high scores in final report (90% or higher).

• Handled all Credentialing needs for a national mail-order Durable Medical Equipment supplier: a. Created database to track and monitor all credentialing documents and their expiration dates, thus eliminating delay in onboarding with new payers due to lack of proper credentialing. b. Worked directly with Billing Manager and CEO to obtain proper signatures and payments for all credentialing needs.• Handled all Contracting needs for a national mail-order Durable Medical Equipment supplier: a. Negotiated all rates and terms of contract with all payers, including commercial and Medicaid in all 50 states. b. Created a protected database in Microsoft SharePoint for entire company to use to verify benefits and rates with customers.• Worked with department leaders to ensure maximum profitability: a. Advised Vice President of Marketing of advertising needs is specific geographical targets to obtain customers from new payer contracts. b. Assisted Insurance Verification team with updates on payer information so verification can be completed quickly and to prevent sending goods to customer.

Miami, Fl, Us

• Decreased call times by providing proper training to staff of 30 Customer Support Agents, five Account Supervisors, and one Departmental Trainer, thus increasing customer retention and increasing profits.• Created new scheduling program that allowed for a reduction in staff while increasing productivity.• Reduced overspending in first year enough to fund a small gym to be built in a conference room for the customer services staff to use.

• Implemented and managed Network Outreach Team, building rapport with 7,500+ health care providers in a contracting campaign, expanding into 6 states to sell Care Improvement Plus product.• Created inter-departmental communication system with SalesForce.com, ensuring provider inquiries and issues were dealt with in a timely and efficient manner, allowing issues to be directed to the right person the first time, as well as accountability to completion.• Developed and managed internal team that reviewed quality of data entered into provider data application by remote team in India and completing primary source verification.

Bachelor Of Science - Bs, Health/Health Care Administration/Management

Associate'S Degree, Accounting

Accounting