Sally Bradley Email & Phone Number

Columbia, Tn, Us

Columbia, Tn, Us

Johnson City, Tn, Us

Oversee team of 23 that performs network development, provider relations, credentialing and enrollment, provider data management, appeals, and grievances for Medicare Advantage, and third-party administrator plan operations. ►Managed administration of managed care contracts with commercial, Medicare, and Medicaid payers in East Tennessee and Southwest Virginia areas. Negotiated contracts and managed programs for a network of 5,900 providers and 17 hospitals.►Interfaced between third-party vendors, Centers for Medicare & Medicaid Services (CMS)-mandated vendors, large provider groups, and Medicare Advantage Pay-for-Performance (P4P) agreement administrators.

Englewood, Co, Us

Championed startup of Medicare Advantage business into Tennessee.►Acquired Southeast region, including Pennsylvania, Tennessee, Arkansas, and New Jersey. Negotiated and maintained P4P and managed care contracts, including large national payers; increased reimbursement for all facilities.►Served as interim market lead in Chattanooga, TN and Reading, PA during managed care director transition; developed Affordable Care Act (ACA) contract.

Hired as first of 5 executives to launch start-up Medicare Advantage and TPA entity; led network development and contract negotiations.►Established and launched Medicare Advantage operations; designed and implemented benefits product, HSD information, and compliance plan to complete CMS application in 8 Eastern Tennessee counties.►Analyzed TPA operations for Mountain States Health Alliance Team Member health plan; established benchmarks and metrics for full audit of delegated services.

Chattanooga, Tn, Us

Managed team of 15 that performed provider and faculty outreach, and administered home-based services, including home health, accessibility modifications, food delivery, and other managed long-term services and support.Previous Position: Principal Network Development Consultant, Medicare Advantage (2009-2011)►Managed provider outreach; reviewed and analyzed network to improve strategy, and reduce deficiencies and reimbursement.►Reviewed single case agreements for out of network services, and negotiated favorable plan outcomes.

Us

Managed 2-person team that developed and grew the Secure Horizons Medicare Advantage product across Tennessee, with matrixed leadership to sales, case management, and network development. ►Surpassed open enrollment membership goals by focusing on senior centers and religious groups; increased membership 10% in one year.

Tampa, Florida, Us

Hired to facilitate start-up of Medicare Advantage and Medicaid products in Georgia. Managed 7-person team. Instrumental in application and award of Georgia PeachCare (Medicaid) contract; managed monthly reporting.

Bachelor Of Arts, History

Master Of Arts, Business