Haley Cunningham Email & Phone Number

Saint Paul, Mn, Us

Saint Paul, Mn, Us

Minneapolis, Mn, Us

Minneapolis, Mn, Us

-- Develop and analyze new and existing Medicare-based fee schedules. -- Analyze current and future contract arrangements for financial impact. -- Support Payment Policy initiatives, by researching & maintaining existing policies, drafting new policies, and seeing policies through implementation. -- Participate in cross departmental Payment Policy Workgroup and Subcommittee.-- Develop and maintain documentation & work procedures for standard projects.

Golden Valley, Mn, Us

--Support the use of TriZetto Facets sub-applications including: Provider apps, Network, Network Sets, Agreements, NetworX Pricer, NetworX Modeler, TCS Letters, etc. --Test and implement yearly software upgrades to Facets & NetworX Modeler. -- Program, test, load letters into TCS letters and Eloquence Author (for use in Aerial program). --Test and load provider agreements and network configuration into Facets, NetworX, & our provider directory. --Analyze and implement unique network configurations to meet employer group needs.

Golden Valley, Mn, Us

-- Develop and analyze financial models to support contract negotiations and enable improvements of contractual pricing agreements. -- Perform analyses for the purpose of creating, developing, and recommending fee schedules and/or payment methodologies, supporting contracting strategies and budget targets. -- Work in SQL server and Microsoft Access to build and load provider fee schedules into claims processing systems (Facets/WERP/Networx/Rate Manager). -- Provide claims reports and RFP’s to support strategic contracting with both new groups and with providers when applicable. -- Customer Focus Cultural Action Team Co-Lead. Working in supporting improving the experience of PreferredOne members as well as the internal 'customer' experience of interdepartmental relations. Organizing/leading team meetings, establishing best practices for projects with co-lead and executive co-sponsors, making recommendations for improvements to the overall customer focus of PreferredOne.

Golden Valley, Mn, Us

-- Identify, analyze, and resolve problems regarding payment, payment policies, claims processing, and contracting issues for in network PreferredOne providers. -- Proactively maintain open lines of communication between providers and PreferredOne, working with my contacts within providers’ offices to ensure a clear understanding of PreferredOne policies and procedures. -- Identify and recommend the need for changes/updates to payment policies impacting provider reimbursement. -- Provide support to contract managers, performing basic contracting responsibilities, proposing standard fee schedules, assisting providers through the contracting process.

Service learning internship, aimed at providing practice opportunities for developing generalist practice skills in a real-world social work setting.--My role at the Center included working in direct practice with first through eighth grade students in Madison, providing them with after school growth and learning opportunities.--Duties included leading a Girl Neighborhood Power Group of first through fifth grade girls once weekly, supervising homework time for all fourth and fifth grade students daily, and facilitating after school programming to build confidence and school success in the middle school (sixth through eighth grade) program three days per week.-- During my tenure at BLW Neighborhood Center, I designed and implemented a peer mentoring program in which our middle school aged students helped tutor the elementary aged students. The older elementary aged students were also invited to stay later, after their elementary programming, to bond with the middle schoolers during the teen program. During this time, I designed and led team building activities for the groups to come together as one unit and to get to know each other. According to a survey the younger students filled out and the end of the peer mentoring program, most of the students believed this peer mentoring activity helped them feel more comfortable in their transition from elementary school programming into middle school programming.

--Filled orders and provided customer support to those accessing and purchasing items from "The Resource Center," a website designed to provide pain resource materials to educators and to those experiencing pain, produced by Dr. June Dahl. I was asked to assist Dr. Dahl in updating said pain resource materials and ensure information is accurate and current. --I was also given the unique opportunity to work on a project geared towards assessing, analyzing, and criticizing existing Prescription Monitoring Programs being utilized in the U.S. This project required reading through each state's individual laws and regulations regarding Prescription Monitoring, marking significant differences in each of their policies along the way. I was then asked to synthesize the data into a spreadsheet and rate the laws and regulations against a series of criteria that we had previously designed and modified to evaluate each of the programs. Finally I was asked to aid in determining a template for how the project would be presented at several educational conferences.

Bachelor'S Degree, Social Work

High School