Accountable for leading all contractual provider network negotiations across multiple health plans and states, including the negotiation and service of strategic, value based contractual agreements. Responsible for the management and monitoring of network adequacy performance defined by Medicare and Medicaid requirements. Acted as primary contact on behalf of provider network with internal inquiries from Compliance as well as State audits of health plan. Assigned as key contact to vision, behavioral health, and meal delivery vendors supporting health plan network.

Accountable for leading all state network development and contract management for a growing and complex managed behavioral health care organization. • Responsible for development of healthcare network thru value add presentations and direct negotiations with healthcare entities to participate in Medicare and Medicaid based health programs. • Accountable for auditing contractual reimbursement terms as applicable to HCPCS codes, per diem rates, including Medicare and Medicaid based fee schedules. • Responsible for maintaining relationships with network providers and state agencies including amendments, and state mandates, and escalated issues for resolution. • Coordinate and oversee the onboarding of provider into network. • Implemented default fee schedules based on Medicare and Medicaid guidelines.

Charged with development of Workers Compensation provider network within the state of Illinois. Serve as primary source of contact with healthcare providers such as hospitals, outpatient facilities, and physician groups for the purpose of participating in select employer panels.• Build contractual relationships with multiple healthcare groups through direct negotiations with mid-level and Senior level management.• Coordinated credentialing applications for facility and physician groups to capture all provider entities participating under the terms of the agreement between payor and provider.• Conducted value added presentations utilizing market claim experience including claim volume, billed services, billed charges, and paid claim data to validate provider network participation.

Held accountability for development and retention of a national network of independent diagnostic medical providers.• Secured detailed agreement terms and gained 1.8% annual overall growth rate.• Aligned objectives with corporate goals to retain network participants and used defined metrics to build reports on network development and profitability.

Drove customer satisfaction by supporting daily operations to deliver insurance claim processing in an effective, efficient manner. Facilitated client calls and explained HMO, Commercial HMO, PPO and Indemnity products to insured.• Primary point of contact for all client service inquiries regarding service, metric performance, growth, and client retention. • Accountable for exceeding service goals with assocaiated performance guarantees. • Responsibe for analyzing, and communicating quarterly, and annual service performance outcomes as compared with contractual service guarantees to describe and discuss reasons for variance.

Managed entire customer experience as ‘single point of contact’ which minimized errors through quality communication and education. Liaison with clients, sales and service operation partners to identify and resolve issues prior to escalation.• Primary point of contact for employer clients for the resolution of elevated service issues and plan benefit interpretation. • Identify needs of employee population based on analysis of employee population and claim experience. • Served as lead contact for external audits and determined accuracy of call and claim administration of plan benefits.

Interfaced with multiple Operations Managers to meet production and revenue goals within negotiations department and offer solutions regarding elevated cases. Attended management meetings and reviewed daily department and client performance reports in order to provide accurate weekly account to Vice President of Operations. Secured production goals and incentive program for staff which resulted in exceeding company goals.• Reduced redundant paperwork and increased availability time for negotiations.• Led team of 17 to a 3% increase in success of total claim volume and gained reduction in savings with each case by 1.5% which improved monthly revenue to $2.4+million in one year.