Lead the out of network claims negotiation team including the development and launch of a consumer medical bill advocacy product. • Streamlined end to end negotiation process resulting in a $0.9M savings increase on book of business for fiscal year 2018. • Product leader for Consilium’s Reference Based Pricing product responsible for ensuring accurate Medicare pricing is provided to all clients.• Created Consumer Medical Bill Solutions website content to highlight competitive advantage and appeal to target customer base.• Leveraged existing medical charge data to direct patients to quality medical care at the most affordable price. • Collaborated with the customer service department to ensure process compliance and expedite the settlement process.

Oversight and direction of proprietary claim evaluation software program to ensure optimum claim routing efficiency.• Evaluated software algorithms within Consilium’s proprietary application to ensure efficient claims routing was at its maximum functionality. • Led a major initiative to obtain direct contracts with healthcare providers who had previously declined single case negotiation.

Led a staff of two claims negotiators and one claims analyst responsible for the disposition of single case settlements for out of network claims from a variety of insurance companies, third party administrators and Taft-Hartley funds. • Facilitated the distribution of high dollar claims to each team member based on the claim complexity, dollar amount and skill of negotiator. • Spearheaded development of new hiring process to include a testing policy and training manual.

Responsible for negotiation of out of network medical claims for national health plans, third party administrators, HMO’s and Taft-Hartley funds. • Audit out of network claims to ensure billing accuracy and errors in accordance with NCCI guidelines.• Developed successful negotiation strategies to secure largest discounts. • Trained new negotiators on the most effective negotiation methods.

Responsible for perfecting a network commitment from physicians of different specialties. • Averaged 20-30 new physicians per month. • Trained new department employees on most effective recruitment methods.

Provided construction services in various capacities depending on the need of the company.Led a construction crew in the completion of various jobs for luxury home builders.Responsible for managing construction materials to ensure adequate supplies for job completion.

In charge of filling patient prescriptions and managing in store supplies.• Worked with insurers to ensure proper coverage for CVS customers• Responsible for keeping online records of patient prescription and insurance coverage.