Evaluating and negotiating large group and Tier 1 group contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls. Including maintaining UCRT targets, Performance Based Contracting metrics, and other reimbursement models. Establishing and maintaining strong business relationships with physicians and ensuring the network composition includes an appropriate distribution of provider specialties. Provide explanations and information to others on difficult issues. Identify solutions to non-standard requests and problems.Assess and interpret customer needs and requirements.Coach and guide others. Build new Networks based on Company requirements, including: Medicaid, TRICARE, and Gated Networks.

Responsible for recruiting new physicians into Network. Build new Networks based on Company requirements, including: Medicaid, Tricare, and Gated Networks. Establishing and maintaining strong business relationships with physicians and ensuring the network composition includes an appropriate distribution of provider specialties. Assess and interpret customer needs and requirements.Evaluating and negotiating contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.

Responsible for reporting of all provider aspects for Contracts/Provider Relations department including utilization data for both claims and referrals/authorizations. Responsible for reporting for HCC, P4P, Encounters, and other incentive programs. Responsible for reviewing of all new contracts and amendments to ensure compliance with policies and procedures and ensuring reimbursement methodology is understandable and complete. Responsible for assisting other contracts/provider relations staff as well as providers with questions regarding claims, referrals, contract interpretation questions, division of financial responsibility questions, and any other issues that may arise. Responsible for training of contracts/provider relations department staff in core system, contracts procedures, internal procedures, and software including Microsoft office, new core system, pricing, etc. Responsible for hiring, training, monitoring, motivating, and disciplining support staff. Assisted Finance and claims department when reimbursement questions arose including capitation and/or fee-for-service reimbursement.

Responsible for monitoring contracted ancillary providers for three-county network. Responsible for negotiating new ancillary contracts for three-county network including Hospitals, hospital-based providers, Ambulatory Surgical Centers, Durable Medical Equipment, Home Health, Radiology, anesthesia providers, and other ancillary providers. Responsible for assisting contracted and non-contracted providers with any questions regarding claims, referrals, or rates in order to ensure all parties are satisfied with the outcome. Responsible for negotiating all contract types for PPO Network. Responsible for negotiating Letters of Agreements and/or Memorandums of Understanding with providers outside of network area to ensure members receive necessary care while ensuring the goals of the company are met.

Responsible for proper adjudication of claims following company, health plan, and government policies and procedures.

Responsible for calling on potential customers to determine what their needs are and how best product could fit those needs. Responsible for demonstrating product to customers via internet/teleconferences and face-to-face meetings. Responsible for attending trade shows to demonstrate the feasibility of product solution to multiple industries.

Electronic device manufacturer specializing in flat panel displays and tubes for television and computer monitor manufacturing. Responsible for managing seven-state region including distributors and manufacturers representative offices throughout the region. Responsible for servicing direct customers from development of new products to include products to delivery of product to customers to meet their deadlines. Responsible for determining trends in industry as well as product trends within company. Responsible for reporting weekly and monthly to upper management the status of region. Developed positive professional relationships with customers, manufacturers representatives, and distributors as well as internal relationships with sales group and factory. Responsible for presenting sales team information at all meetings including monthly sales meetings.Managed monthly forecast report, managed monthly sales reports, and developed weekly and monthly reports.