Sandra Pearson Email & Phone Number

San Diego, Ca, Us

-Contract applications and credentialing for both commercial and government payors, as well as Laboratory Benefit Managers-Contract review and negotiation-Contract financial analysis, both for fee schedule negotiation and to determine ROI post contract implementation-New contract implementation and setup (both provider and payor)-Development of new contract Sales and Marketing Materials, as well as pull through strategy-Prior Authorization Program implementation and monitoring-Provider Education around Prior Authorization and Medical Necessity/Medical Policy-Revenue Cycle - Bad Debt analysis to include review of denied claims for identified trends and solutions to resolve (i.e.; PA andMedical Necessity Review prior to service, Review of Medical Necessity Denials and Appeals, etc.)-Hospital and Hospital owned provider education for Billing, Pass through Billing, Prior Authorization, Medical Necessity, etc.

Carlsbad, California, Us

Carlsbad, California, Us

Carlsbad, California, Us

Recruited to participate in the development and implementation of Genoptix reimbursement and market access initiatives. Through the achievements listed below, secured access to more than 10 million insured lives to boost annual sales growth to more than $35 million dollars.Develop action plans for regional and national market access contracting efforts. Identifies and prioritizes negotiation of all regional and national contracts through market / financial analysis and modeling to identify market share and increased opportunities and threats. Evaluated net revenue impact of contract & volume changes. Collaborates with corporate and regional sales management, to assess the strengths and weaknesses of the company’s contracting, reimbursement, and market position strategies. Establishes and maintains relationships with Sales and Billing departments in resolution of reimbursement and client related issues. Key Achievements: -Closed multiple large Payor Contracts including Arkansas BCBS and BCBS LA to increase access to 2.5M additional covered lives. -Developed post contract growth plan including the creation of Marketing Materials, establishing sales targets, and monitoring growth of current and new business reaching 20% increase in sales. -Negotiated and finalized the Avalon Healthcare Solutions contract adding an initial 5 Million covered lives under BCBS SC and BCBS NC products.  -Finalized the BCBS AL “Case Rate” Agreement . This Plan has 97% Market Share in the state covering 4 Million lives.  -Successfully negotiated local, regional, and National Payor Contracts including Windsor/Sterling, Vantage Health Plan, Coventry, People’s Health Plan, Humana, Aetna, and Mississippi Physician Care Network to solidify and grow regional market share within the organization.  -Completed contracting with IDNs Health First Health Plan (Florida) and Phoebe Health Partners.