Advised telehealth and digital health startups on strategic initiatives, driving operational improvements and enhancing scalability.Collaborated with leadership teams to streamline credentialing and enrollment processes, ensuring compliance across multiple payors and improving overall efficiency.Conducted in-depth analysis of operational data to identify inefficiencies, recommending and implementing process improvements that boosted organizational performance.Developed scalable solutions for startup environments, focusing on optimizing telehealth workflows and enhancing digital health service delivery.Provided strategic guidance on technology implementation and regulatory compliance, aligning operational changes with business goals.

Managed the onboarding and credentialing process for new MDs, PAs, NPs, and Dieticians, ensuring compliance with Medicare, Medicaid, and commercial payors through accurate application submission and documentation.Maintained and updated provider CAQH profiles, collaborating with enrollment, licensing, and Continuing Medical Education (CME) vendors to streamline processes and ensure compliance.Played a key role in payor strategy development and operationalizing contracts, including negotiations and benefits verification to assist patients in understanding their coverage and costs.Developed and implemented a comprehensive revenue cycle management process, optimizing billing practices and collaborating with the product team to automate 100% of claim submissions for improved financial performance.

Developed and executed business strategies in collaboration with the executive team, resulting in an 80% increase in health plan enrollments and improved overall business performance.Led and managed a remote and international team of Leads and Analysts focused on the auditing and maintenance of provider data, ensuring accuracy and compliance in network participation applications.Cultivated strong relationships with existing customers, serving as the primary point of contact to address inquiries and provide effective solutions to enhance satisfaction and retention.Implemented strategies to reduce churn and improve client retention rates by proactively identifying at-risk clients and resolving issues before they escalate.Created and delivered training sessions, webinars, and educational resources, empowering clients to maximize their use of products and services while tracking key performance indicators (KPIs) related to customer success.

Expanded provider network from 8 to 85 providers, driving significant growth in service coverage and availability.Managed end-to-end provider acquisition and onboarding processes, streamlining workflows and ensuring seamless integration into the network.Developed automated processes for provider engagement and appointment booking, reducing manual work by 40% and improving operational efficiency.Led social media marketing efforts across LinkedIn, Instagram, Facebook, and company newsletters, increasing online engagement and brand visibility.

Developed and delivered training sessions for new hires and ongoing sales education, driving continuous skill development and product knowledge within the team.Created and maintained sales content, including presentations, white papers, and case studies, ensuring up-to-date and impactful resources for the sales team.Collaborated cross-functionally with marketing, product, and customer success teams to align on sales initiatives, improving coordination and support for post-sales efforts.Continuously optimized and standardized sales processes, leading to a 15% increase in product adoption and improved sales efficiency.

Managed relationships with a major New York network partner, Montefiore, and all Medicare Advantage provider groups in the Bronx and Upstate New York, ensuring provider engagement and network success.Served as an on-site resource, providing support and education to new providers joining the network, enhancing integration and alignment with Oscar’s Medicare Advantage product.Streamlined team workflows by transitioning to a scalable platform within JIRA, reducing manual work tracking by 45% and improving overall efficiency.Improved provider engagement by facilitating strategic interactions between Oscar’s senior leadership and key provider organizations.

Closed high-impact network gaps in the Dallas, Texas market, securing Oscar’s approval for market expansion in 2020 by identifying and contracting with key provider groups.Negotiated dozens of contracts with provider practices, ensuring geographical coverage met regulatory access standards for market entry.Developed and implemented a "guardrails" system in collaboration with legal, pricing, and leadership teams, streamlining contract negotiations and reducing the need for redline escalations.Implemented a contract tracking system that improved compliance with legal and regulatory standards, cutting manual redline negotiations by 20%.

Fully migrated Provider Relations team operations from Google Sheets to JIRA, improving cross-functional collaboration and escalation handling.Developed and maintained JIRA dashboards, providing real-time tracking and insights for a team of 4-5 processors managing provider escalations.Led an inbound team responsible for intaking, documenting, and investigating provider network escalations, ensuring timely resolutions for claims, billing, and provider data issues.Managed key accounts in Texas and Ohio markets, including Baptist Health System, Baylor Scott & White, and Cleveland Clinic, overseeing escalations and maintaining strong provider relationships.

Pioneered the utilization review role for non-clinical support staff, enhancing collaboration between clinical and operations teams.Managed all inbound and outbound communications for Utilization Management (UM), triaging calls and faxes, coordinating approvals, and adverse determinations, and scheduling peer-to-peer reviews with network providers.Developed and maintained JIRA dashboards for the UM Processor role, providing real-time insights into workflow and performance metrics.Coordinated with Provider Relations, Claims, Eligibility & Benefits, and Patient Care Teams to resolve escalated provider and patient issues.