Effective leader and relationship builder that supports high quality network base in new and mature markets. Leads network issue resolution. Uses creative innovation methods and techniques to support healthy collaboration. Partners effectively with senior leadership executives with focus on data analytics and performance management. Assists with contracted network development.

Implemented company’s processes into daily workflows and delivery of care for assigned Northern California’s delegated independent physician associations (IPAs) and medical groups. Acted as key liaison between multiple internal and external business partners to address problems and concerns including claims and member-related issues via prepared presentations and audited data. • Served as leader and role model for developing strong relationships with 5 assigned IPAs / medical groups, facilitating effective and meaningful discussions that produced constructive action items toward driving quality improvement that positively impacted P&L.• Created specific and measureable plans based on key performance indicator reports that drove quality performance improvement in concert with all functional areas including sales, clinical, pharmacy, Medicare risk, and quality.• Generated increased profitability for 2 low-performing groups by leading health services projects and initiatives, identifying facility contracting opportunities that resulted in significant cost savings for member, providers, and health plan.• Trained 9 colleagues, serving as subject matter expert (SME) on specific benefits, DOFR, policies and procedures, and dashboards (financial, quality, and clinical trends).• Acted as key liaison between multiple business partners, identifying, recommending and resolving problems and concerns via prepared presentations and audited data.• Promoted and managed continuum of value-based opportunities by identifying high ER utilizers that could benefited from education, complex case management, or pharmacy education, with decreased out of pocket expenses while achieving healthier outcomes.

Supported providers and communicated with clients to facilitate greater physician understanding and cooperation during contracting process. Acted as liaison between multiple business partners to identify / resolve issues. Triaged assignments based on urgency and ensured escalation when necessary. Worked with POD team to coordinate meetings / projects, including managing SharePoint site, and preparing / disseminating reports.• Recognized as 2014 Humana Star Award Recipient for creating, sharing and presenting new concept of provider operations SharePoint site.• Demonstrated instrumental leadership skills in working internally with management, consultants, and other areas in setting up / tracking meetings, improving overall efficiency and performance.• Applied expertise in knowledge of claims, provider relations, IT, customer service, contract management and analytics, triaging and resolving claim issues between providers and company’s service fund.• Utilized analytical skills, project management and SME to research / resolve issues and improve effectiveness of coordination efforts over Medicare Operations Network by implementing policies for knowledge and document sharing on California market SharePoint site.• Trained 2 new specialists on multiple proprietary corporate systems, products, and processes.

Maintained provider database containing contractual elements that were used to process claims and submit internal, external and state reporting requirements and directories for Stanislaus and San Joaquin Counties. Held in-depth knowledge and expertise in understanding basic claims billing fundamentals limited to Medi-Cal, TPA, commercial, and managed care plans.• Conducted ongoing training to staff, including Medical Management, Contracting, Provider Relations, Credentialing, data management processes, procedures, and QNXT (claims processing and provider database software) logic and functionality that promoted best practices.• Facilitated interdepartmental meetings that updated key stakeholders on provider data management's monthly production and any policy / procedure changes.• Served as SME for staff and external vendors, becoming member of annual system selection team and HEDIS reporting project teams.• Held roles of SME and liaison for configuration team to develop contracts and specialty logic, ensuring compliance with contract agreements, NCQA, DHCS and taxonomy coding while assisting and providing input for QNXT implementation and stabilization phases.• Developed and maintained current data exchange policy and procedures, and workflow processes with Contracting and Provider Services, meeting required annual state reporting submission to Department of Health Care Services (DHCS).