Serve as a liaison between designated High Touch Clinicians and the Plan for GHI, HIP and Emblem Health through field activity related to provider recruitment, education and service. -Conduct over 500 bi-annual onsite visits within territory to assist with provider issues, education materials, communication of Plan policies, and procedures and Plan strategic initiatives.-Analyze provider requests for enhanced fees and modify contract and fee schedule if necessary.-Identify provider reimbursement trends to assist in development of provider contracting strategies. -Recommend innovative contracting strategies to maximize cost containment through provider arrangements.

Hospital and Facility Advocate in specialized department created to focus on specific provider and hospital claim issues.- Supported high volume groups and achieved numerous million-dollar recoveries for groups, including Catholic Health Services, SUNY, NYU Physicians, NUMC and Helen Hayes.-Provided high level of hospital and provider satisfaction through successful reprocessing of claims to contracted rate.-Partnered with teams involving dozens of collegues cross-functionally throughout departments, involving contracting, claims project management and data loading to resolve issues with products, such as Community and State, Commercial and Medicare.-Developed MS Excel tracker to monitor progress and resolution of issues for Providers and facilitated biweekly and/or monthly meeting to work, collaboratively.

Acted as resource for unresolved issues through regular customer service channels to strategize and find successful solutions for providers.• Managed United Healthcare’s 20 High Level Providers • Liaised between provider network and United Healthcare maintained relationship with territory of 60 providers.• Educated network on changes to contracts and respective impact to customers.• Researched and resolved claims issues for providers within territory.

Managed successful transition of Long Island Provider Relations staff and resources to NYC office.• Developed new policies regarding Office Based Surgery procedures. • Effectively represented department by presenting topics at Quality Leadership Committee (QLC) and Quality Improvement Committee (QIC) meetings.

Developed, inspired and managed team by implementing transformational strategies and efficiency measures.• Managed negotiation of fees and exception memos for providers.• Supervised staff of 10+ Account Executives and Assistants while maintaining relationships with 4.5K Providers. • Spearheaded revision of Practitioner Handbook to maintain current polices. • Initiated incentive plans to increase recruitment of providers within network.

• Recruited new providers to join Vytra to expand provider network.• Consistently met goals in performing over site visits and orientations in a territory of 450 providers.• Informed provider network on a continual basis of Vytra’s policies/procedures to increase provider retention.

• Resolved claims issues as reversing and reprocessing claims payments.• Coordinated overpayment procedures to members and providers.• Evaluated and adjudicated member appeals