Ellen M. Chiaramonte Email & Phone Number

Ft Lauderdale Fl

Greater New York City Area

● Provider contracting and rate negotiations for Medicaid, Medicare and Commercial based managed care organizations on a project basis.● Utilizes demographic data and research tools to identify target providers and fill geographic and specialty network gaps.● Ensures timely deliverables to successfully meet project objectives and client deliverables.

Minnetonka, Mn

● Assisted with daily living activities and personal grooming.● Administered medications and ensured that all prescribed therapies and exercises were completed.● Maintained appointment schedules and provided transportation to all appointments.● Documented behaviors and reported abnormalities or new symptoms to medical personnel.● Managed all aspects of household maintenance including housekeeping, grocery shopping, meal preparation, mail collection and bill paying.

Iselin, Nj

This was originally a 90-day contract but the company liked my performance and extended my contract for more than six months. My main responsibilities were to recruit and negotiate contracts with health care providers to mitigate regulatory network deficiencies. I did this under challenging market conditions, due to lack of participating hospitals in certain counties.● Negotiated and closed contracts among physicians, medical groups, and the insurance company.● Improved GeoAccess compliance rates by 75 percent in a six-month period.● Managed churn and turnover with contracts affected by network hospital terminations.

Mt. Laurel & Wall Nj

• Was responsible for monitoring and recruiting health-service providers across a wide territory of New Jersey, Pennsylvania, and Delaware• Honed and showcased my data management and other research skills as I mined and analyzed data to identify opportunities to recruit new providers into our Managed Care &/or PPO networks. This resulted in eliminating either geographic or specialty gaps or achieved the goals of specific business strategies or initiatives. Similarly for identifying exceptions to standard fee schedules based on network need or unique circumstances and successfully negotiating and contracting with said providers. • Was responsible for the creation and maintenance of numerous reports, including those regarding the credentialing status of high priority physicians and hundreds of physicians and allied health professionals affiliated with the Faculty Practices of several hospitals that became participating within my territory. Met regularly with key Credentialing personnel to ensure the timely completion of that process. • Attended all scheduled and ad hoc Credentialing Committee meetings.• Represented the Physician Recruitment and Contracting team at regional meetings and seminars hosted by the Physician Relations department.

Mt. Laurel

• Managed health service contracts and performance over a large assigned territory.• Established, nurtured and maintained robust relationships with physicians, high profile groups, Independent Practice Associations (IPAs), and Federally Qualified Health Centers (FQHCs) with diligent communications and face-to-face visits. Set a record by making 700 annual office calls.• Educated providers and/or staff on company policies and procedures, disease management programs, and quality incentives. Surveys documented a measurable increase in provider satisfaction over this period.• Used advanced data tools to conduct accurate research to follow up complaints and to make the case for or against special fees. • Managed and completed complex projects for both reporting and compliance, such as: Health Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Health Plan Survey (CAHPS), NCQA, National Provider Identifier (NPI) Collections, Quality Improvement, Consumer Driven Healthcare (CDH) Education, LabCorp Requisitions, Capitation Conversion Outreach, and Non-responder Outreach.• Was commended for professionalism and attention to detail. My success in this position earned me the promotion to Physician Relations Representative II.

During my employment here, I held additional positions (e.g. Marketing Representative; Member Educator; Community Relations Representative; Provider Recruiter; Provider Relations Representative). The dates indicated above represent my entire span of my employment. The duties described below are specific to my last position, which I held for approximately 4 years.• Effectively managed a large network of health service providers for the Medicaid division of New Jersey’s largest medical insurance company.• Outperformed expectations for a one-time recruitment of doctors needed to address an expansion of membership by 20,000 patients. Overall was able to increase one county’s provider network by 75 percent.• Supervised 6 internal support staff.• Assiduously covered the territory, making 50 visits to physicians and FQHC locations per week. Ensured that complaints and billing discrepancies were resolved promptly.• Educated providers and their staff on Patient-Centered Medical Home (PCMH) philosophy and Cultural Diversity.• Completely fluent in complex details regarding policies, procedures, and legislation; regularly provided informative briefings to health-service providers and to other interested parties.• Used subject matter expertise and leadership abilities to supervise support personnel and to train new employees on data systems for HIPAA compliance.• Mastery of statistics, databases and policies served to keep the company ahead of the curve on reimbursement schedules and spot-checking for deficiencies. Kept close control of data to maintain compliance with reporting requirements of Sarbanes-Oxley (SOX) statute.