Managing insurance contracting for AZ, CA, UT, HI, and WA. Specializing in Medicare Advantage, Commercial, Duel Eligible, V.A., Managed Medicaid and Hospice Insurance. Development and implementation of process system to ensure accurate and timely payment.

CONTRACTINGContracting done for: Med Advantage, Commercial, Duel Eligible, Veterans, Hospital, and Hospice. Inquire about new contract possibilities.Write as requested letter of interest.Review business side of contract language for payment and clinical issues that must be addressed Review Insurance saturation for coverage area.Research insurance quality ratings, subsidiaries, and coverage areas Read the insurance provider manual insuring compliance can be met Review possible acceptable rates, exclusions and inclusions. Complete Contracting processAssist in payer set up in billing system. Do reviews as neededKeep up to date on changes to the PPS system and how it impacts current and potential contractsUTILIZATION Maintain my created Systems that insures Insurance book of business generates and maintains optimal revenue. This has been 100% effectiveMaintain and update the master formulas of the system.Monthly reports sent to Billing manager and regional vice presidents with potential payment issues. On call for all Facility staff to answer admission inquiry questions and/or reauthorization issues. Review, negotiate and approve Single case agreementsResolve payment issues for MA/Insurance so payment is received.Follow criteria for approved Level of care in comparative to LOC authorized. Writing Policy on MA/ insurance that incorporates all the above informationOngoing research changes to: Affordable care act, ACO’s, Medicare and, MA PPS MDS submission data.Updating and maintain policy’s in relations to my scope of expertise. Write , maintain and conduct training. Trainings provided i.e.MA/Ins. Common MistakesHow to Run, Read, and do the supporting documentation for the CWF.How to work with (insert new insurance contract here) .Medicare PPS MDS’s monitoring .Oversight, with facilities in all aspects of MDS’s including training, submission and corrections

Visited Phoenix and surrounding cities health care facilities. Looking for referral that would lead to new clients Provided communities with education and tools to establish Power of Attorneys and Advance Directives. Provided healthcare facilities information on the public benefits programsDid benefit analysis to determine if public benefits would be available for that person.Initiated and preformed training presentations to all level of professional providers and for pubic education in surrounding communities.Maintained social service data on clients Problem solving for clients

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