Mark Swick Email & Phone Number

Phoenix, Arizona, United States

Columbus, Ohio, United States

Healthcare Services Consultant performing as a Network Contractor under the direction and supervision of TriWest Healthcare Alliance. Securing contracts with all provider groups, ancillary, and hospitals per TriWest’s direction. Mastered Systems and Applications such as Salesforce/Apttus, Anchor Point, Visual Cactus, Care Radius, TW 360, SSRS Self Service Reporting (Restricted), Tableau Reporting and more. Assisted in Region 5 Alaska buildout by securing FQHC’s, LexisNexis file scrubbing for additional Alaska providers to ensure TriWest met the projected network in the state of Alaska. Secured more than 75 SCA’s, both MDA and Non-MDA. Assisted with BS of California Credentialing project capturing lagging credentialing documents. Teamed up with DCM’s on the DCT project securing contracts in areas where VA is lacking coverage. I’ve volunteered and am currently filling the role of the DCM for the state of Nevada.

Columbus, Ohio, United States

Promoted to Project Manager, Network Development in February of 2020. Essential duties include planning and implementation of projects. Also responsible for creating timelines with contract recruiters to discuss strategies and task management; monitor and report progress to business leadership, proactively manage details throughout projects, and work with all members of the team across multiple departments/locations.

Columbus, Ohio, United States

Provide QA of reporting activities to support the business needs between all departments of the company. Accountable for QA of data entry into the CRM, analyzing reports derived from CRM system(s) to establish accuracy prior to delivery to clients. Responsible for oversight of reports generated out of CRM system(s) as well as tracking and submitting QA results and related activities to appropriate departments for needed updates and or adjustments. QA of all client facing reports including negotiation activity and productivity. Data Analysis and ad hoc reporting.

Lake Forest, Ca

Promoted in September 2016 to Network Development Executive, Network Development. Assist management in the identification and development of client priorities for assigned territory. Negotiate contracts to support penetration and revenue objectives relative to competitive market trends and client expectations. Foster and maintain superior relationships and work closely with affiliates such as, First Choice Health Network, Managed Healthcare Northwest, Intermountain Healthcare and Health Management Network managing their networks. Prepare analyses, reports and presentations by collecting, analyzing, and summarizing information and trends. Work with Regional Sales and other Account Management Associates to respond to and anticipate access requirements and network related performance guarantees. Ensure compliance with established regulatory requirements and mandatory training requirements (such as but not limited to HIPAA, NCQA, integrity, product orientation and some contracting). Collaborate, coordinate and communicate across disciplines and departments.• Participated on project team for testing and implementation of Contract Management System (Salesforce) to streamline and increase time efficiencies with contract processes and approval flows.• Worked closely with Network Contracts to ensure monetization of over $40 million claim dollars toward the Regional goal of $350 million over the last 2 years.• Assisted National Ancillary/Government Team with build out of Medicare Advantage and ECP initiatives.

Lake Forest, Ca

Transferred to Network Development as a result of a major re-organization due to the merger of Beech Street and Multiplan, Inc. Negotiate provider contracts to support penetration and discount objectives relative to competitive market trends and client expectations, foster and maintain superior provider relationships, prepare analyses, reports and presentations by analyzing trends, work closely with Regional Sales and Account Management Peers to respond to and anticipate access requirements and network related performance guarantees, ensure compliance and regulatory requirements such as HIPAA, integrity, product orientation and contracting resources, and working directly with Legal Peers to ensure complete and accurate compliance.• Trained 3 new Contractors to support acquisition of affiliate PPO network resulting in expansion of PPO Network by over 50,000 providers.• Secured Network Contracts monetizing over $30 million dollars toward Regional goal of $347 million over the last 3 years.• Completed integration and testing of demographic data and rates from acquisition of affiliate PPO Network resulting in expansion of overall Network by 47 Hospitals, 4730 Practitioners and 1,100 Ancillaries in the states of Arizona, Nevada and New Mexico.

Lake Forest, Ca

Managed staff responsible for electronic uploads ensuring data integrity. Monitor individual employee performance, provided feedback and training. Contribute to development, implementation and communication of department policies, procedures and workflow. Responsibilities included measuring and reporting outcomes and objectives.• Successfully developed, and implemented, workflows for network integration projects. Contracted directly in the state of Virginia to replace the Affiliate PPO Network Virginia Health Network resulting in savings of over $100,000.00 annually for leased network cost.• Interim Project Manager for two Leased Network integrations.• Implementations of provider group upload accounts from manual to electronic upload process. Increased number of monthly updates by 60% with decrease in manual data entry errors and reduction of staff by 3 full time employees.

Lake Forest, Ca

Responsible for Management, implementation and maintenence of EDI files, facility and physician rate load, demographic load, and claims history files. Responsible for all aspects of leased network and large group electronic uploads; generation of Utilization Management reports, Utilization Management re-writes, CPT and ICD-9 file maintenance, ad hoc queries and reports, internal and external customer requests and support of Quality Regulatory Management for State Certification and Accreditation.• Created the Utilization Management reporting tool that identifies savings and Return on Investment (ROI) by product. Quarterly reports provided to Clients in order to assist with patient care efficiencies.• Identified and documented high volume of misrouted client inquiries, enabling the transition of approximately 70% of these inquires to the appropriate departments for resolution.

Certification, Managed Care, 4.0

Activities and Societies: Managed Care Claims and Business Administration Skills• 1996-HIAA Managed Care – Integrating the delivery.

Certification, General Studies, 4.0

Activities and Societies: Workers' Compensation CA8 thru CA14 courses....• CA8 – Worker’s Compensation for non-technical personnel • CA10.