Melissa Stagg Email & Phone Number

Work At Home

• I manage and coordinate all new market deliverables for assigned new business• I clarify, translate and operationalize RFP requirements to address issues and gaps for network adequacy submission and any systems-capable issues• I compile, organize and align provider data from multiple internal and external data sources to comply with RFP and/or new market requirements• I quarterback and coordinate information-sharing with multi-disciplinary teams to ensure compliance with State requirements for network builds, network strategy, network modeling and adequacy reporting• I lead business requirements and infrastructures for RFPs and new market deliverables• I manage the post-implementation transition and stabilization issues for market deliverables and State requirements before hand-off to plan leadership

Greenville, South Carolina Area

Build and manage MSO network for Medicare Advantage HMO/PPO limited risk agreements in South Carolina Responsible for establishing, maintaining and oversight of provider risk agreements and relationships Provide detailed analysis, training, reporting, education and partnership with provider groups to achieve performance metrics Collaborate with Finance and Management on utilization patterns, trends, cost savings opportunities and performance gaps Facilitate and implement STARS, HEDIS and Medicare Risk Adjustment for improved quality and clinical outcomes Identify opportunities in specialty network for efficiencies and best practices Manage provider groups roster load to assure appropriate attribution for performance and expense reporting

 Educated and engaged providers in Humana network by developing strong partnership and working relationship to promote Humana growth Built and managed the Medicare PPO network for transition to Medicare HMO in South Carolina Engaged provider community to participate and comply with Humana products, policies and procedures Liaison for key healthcare providers, such as Greenville Healthcare System (GHS) in South Carolina and Carolina Health Systems (CHS) in North Carolina Executed Humana Provider Engagement strategy for Physician Rewards programs, such as STARs, Model Practice and Patient-Center Medical Home Analyze reporting to decrease costs in leakage

Work At Home

Negotiated and managed hospital, physician and ancillary contracts for 22 counties in South Carolina for Worker’s Compensation and Medicare business Accountable for engagement of contracted hospitals and large ancillary provider to assure continued participation Served as key liaison between key provider organization and Aetna operations (management, finance and claim teams ) for problem identification and resolution Led the team for Medicare network development in selected counties in North Carolina and South Carolina Mentored and coached team members to achieve company goals Facilitated special projects with hospitals to improve billing practices and quality measurements

Work At Home

 Negotiated and managed physician and ancillary contracts for 35 counties in South Carolina Assisted with financial reporting and cost analysis for hospital contracts Developed strong relationships with network providers and internal business partners to achieve provider engagement, medical cost targets, network growth and efficiency targets Facilitated retention of key hospital contracts Participated on a network expansion team Negotiated increases on contracts to achieve the target medical cost ratio Participated on team targeting cost reduction opportunities in South Carolina Participated on Worker’s Compensation expansion team for South Carolina coverage

Work At Home

 Negotiated and managed physician and ancillary contracts for 35 counties in South Carolina Assisted with financial reporting and cost analysis for hospital contracts Developed strong relationships with network providers and internal business partners to achieve provider engagement, medical cost targets, network growth and efficiency targets Facilitated retention of key hospital contracts Participated on a network expansion team Negotiated increases on contracts to achieve the target medical cost ratio Participated on team targeting cost reduction opportunities in South Carolina Participated on Worker’s Compensation expansion team for South Carolina coverage