Sandy Sawyer Email and Phone Number

Negotiated contract terms and established contractual relationships with high complexity inclusive of Hospital Based Physicians, Behavioral Health, Independent Clinical Labs, Dermatology, Gastroenterology, Ambulatory Surgical Centers, Skilled Nursing Facilities, Birthing Centers and Telemedicine. External executions of operations initiatives: self-service tools retail and projects. Led Project Analyst in activities to ensure completion of multiple Projects including Genetic Counseling, Telemedicine and Out of Network Lab Leakage reduction. • Identified contractual Performance Guarantees resulting in repayment of over $5 million in revenue, and further risks resulting in out-of network leakage reductions. • Managed, developed and maintained internal and external reporting for behavioral health network and independent clinical labs contractual performance network, as well as, various other specialty types.• Established payment allowances and pricing methodology for new CPT codes and established codes.• Executed and implemented high complexity contractual arrangements with internal business partners. • Implemented corrective action to enhance network performance and monitor results.• Proactively communicated and trained vendor/providers on administrative policies, business processes, capabilities and initiatives.

Director of Provider Engagement responsible for coaching statewide team, assisting both providers and patients with product offerings. Experienced Healthcare Leader with a demonstrated history of working in the health care industry. Skilled in Relationship Building, Project Management, Microsoft Office, Coaching, Planning, and Network Building.

Prepared, analyzed, reviewed, and projected financial impact of larger or complex provider contracts and drafted alternate contract in South and West Florida regions.• Negotiated and drafted individual PCP and multi-specialty contracts throughout South Florida, Treasure Coast and Fort Myers regions resulting in zero network access gaps. • Tracked financial performance of contracts and compliance within contracting.

Responsible in the development and mentoring professional Account Executives to successfully create a delivery system for Medicaid and Medicare members. Negotiated new and existing provider agreements for South Florida physicians while effectively working with Sales Managers, Agents and Brokers in recruiting providers for new member enrollments.• Implemented team-building activities in order to strengthen cohesiveness among direct report professionals, as well as, internal and external business partners resulting in employee retention year over year.• Executed and participated in earnings improvement opportunities including Capitation and Risk Contracting • Negotiated new and existing provider agreements for South Florida physicians.• Ensured that providers received appropriate education regarding health plan protocols.• Evaluated the provider network to ensure appropriate access for membership. • Interfaced with all other departments to ensure appropriate configuration of contracts, reimbursement rates and benefits. • Recommended and drafted communications relative to health plan policies and procedures.

Negotiated favorable contracts and recruited new physicians for HMO Networks for both Medicare and Medicaid members. Facilitated resolution of member/provider inquires relating to eligibility, contract and benefit issues. • Conducted educational in-service meetings for North Broward County Florida new and existing providers resulting in familiarity of health plan procedures.• Monitored monthly utilization levels of contracted physicians to ensure providers referrals were within limits and reducing hospital visits or out of network referrals.