• Accomplished multiple tasks within established timeframes.• Developed the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management.• Reported and assessed contract performance to leadership.• Worked with payor contracts to find resolutions for escalated issues.• Set up and managed contracting information database including term language, incentives, fee schedules and other pertinent information.• Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Established and maintained strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensured network composition included appropriate distribution of provider specialties. Achieved 95% network adequacy for specialty network within 6 months.

• Work with a dynamic team focused on healthcare growth including operations, market, and revenue cycle analytics. • Analyze, prepare, and report on financial performance of contracts including but not limited to delegated risk, specialty and ancillary capitation and referral trends and utilization data.• Oversee the monthly entry and analysis of standard utilization and employment statistics.• Month end reporting and analysis for finance and accounting.• Develop and supported business requirements reports.• Develop data products using SQL Server, SSRS, Tableau and other tools as necessary to deliver needed insights.• Integrate data from multiple sources and build processes to assure data integrity and report outcomes.

• Developed and supported business requirements reports.• Monitored and validated data warehouse to ensure data integrity.• Assisted in developing and implementing a practice quality performance measure and analysis process.• Acted as the single point of contact for bonus allocations to contracted providers. • Participated in internal and external facing committees and taskforces as needed.• Recommended and directed more efficient automation for solutions to business problems.

• Analyze, prepare, and report on financial performance of contracts including but not limited to delegated risk, specialty and ancillary capitation and referral trends and utilization data.• Assisted in developing and implement a practice quality performance measure and analysis process.• Acted as single point of contact for bonus allocations to commercial contracted providers.• Monitored and validated system to ensure data integrity.• Developed and supported business requirements reports.• Subject matter expert for team on Excel, Access, SQL Server and Crystal Reports.• Recommended and directed more efficient automation for solutions to business problems.• Participated in committees and taskforces as needed.

• Assisted in the maintenance of databases including data definitions, design of tables, reports, queries, forms and macros in Access and SQL Server Databases.• Monitored and validated system to ensure data integrity.• Developed and supported business requirements reports.• Assisted with developing user training manuals and process and procedure documentation protocols. • Recommended more efficient automation for solutions to business problems.• Developed and supported process for analysis of claims based hospitalizations and procedures for overpayment identification.• Participated in committees and taskforces as needed.

• Assist in the maintenance of financial and clinical claims databases including data definitions, design of tables, reports, queries, forms and macros in Access and SQL Server Databases.• Develop and support business requirements reports.• Develop and support process for analysis of claims and clinical measures for contract year-end reconciliation and fiscal and performance measurement.• Maintenance of all contract documentation, contract summaries and process workflows. • Create, review and distribute monthly invoices to contracted customers.• Recommend more efficient automation for solutions to business problems.• Assist in the development, testing and maintenance for financial QI and QA protocols. • Develop and support processes for analysis of claims-based hospitalizations and procedures.• Participated in committees and taskforces as needed.• Provided account management to health plan customer; acted as liaison between support team and customer; assisted in organizing, identifying and resolving issues and/or concerns.