Kathleen M. Gibson

Kathleen M. Gibson

**** ******* ***

Cincinnati, OH 45209

513-***-****

acfpcy@r.postjobfree.com

Motivated, dedicated, and confident professional with a broad and unique skillset in the healthcare industry,

producing quality outcomes through networking, innovation, and personal and professional drive for excellence

in healthcare.

PROFESSIONAL EXPERIENCE:

Humana, Inc.

Cincinnati, Oh

Medicare Provider Relations: April 2005-Present

Responsibilities include territory management for Medicare Advantage Providers for Dayton, Cincinnati,

Northern Kentucky, S/E Ohio and S/W Indiana . Assist in the design and implementation of programs to build

and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and

practice managers. Support those who direct and implement strategies relating to the development and

management of a provider network, identify gaps in network composition and services to assist the network

contracting staff in prioritizing contracting needs, and researching and remediating claims.

Other Role Responsibilities:

Identify Key Performance Indicators and use pertinent data and facts to solve a range of problems.

Serve as focal point for Provider risk group questions regarding financial settlement, physician reward

program, and funding.

Train providers regarding reports and data sets available through the appropriate internal accounting

applications.

Provide operational support for Market Point Medicare Advantage sales managers and agents in order to

positively impact growth in membership.

Major Accomplishments:

Assisted in implementation of the Medicare HMO plan in Cincinnati effectively educating over 2,000

physicians on HMO product parameters and guidelines.

Effective in migrating 2,000 providers in the Cincinnati market on the continuum from Private Fee for

Service to Medicare PPO to Medicare HMO and on to path to risk agreements.

Led project management for the introduction of the Passive PPO plan to providers for the OPERS

members.

Recognized as a STARS award recipient for OPERS provider education.

Actively participated in the education of providers in Kentucky and Florida for Kentucky Teachers

Retirement System increasing membership by 20,000 for the Kentucky market.

Humana, Inc.

Cincinnati, Oh

Network Operations Representative June, 2004-April, 2005

Responsibilities included assisting in collecting and formatting data in accordance with department needs.

Manage and monitor internal communications. Maintain databases for tracking and trending purposes. Create

Kathleen M. Gibson

and review reports tracking new physician, hospital and ancillary contracts. Assist management in development

of new physician networks. Assist with auditing process to ensure database integrity. Review current internal

processes and assist in any process improvement opportunities.

Major Accomplishments:

Implemented state wide provider seminars giving physicians, office personnel and practice

administrators an opportunity to learn about any product changes, new plan roll out or general

healthcare industry changes.

United HealthCare

Cincinnati, Oh.

Network Account Manager Feb, 2001-Jan, 2004

Responsibilities included managing relationships with individual physicians and medical groups paid on a fee-

for-service basis. Facilitate and complete financial analysis of all reimbursement proposals. Determine network

adequacy and recruit new providers to fill any identifiable gaps. Maintain strong working relationships with

ancillary departments throughout United Healthcare, as well as United HealthGroup relative to claims

resolution and contract load activities. Identify provider education opportunities, and coordinate and deliver

appropriate training materials. Prepare and facilitate operational meetings with the providers.

Paragon Health System

Cincinnati, Oh

Provider Relations Representative, March, 1998-Feb, 2001

Responsibilities included front line support for the network management department of Paragon Health System,

medical management company for Anthem in Cincinnati. Coordinated credentialing activities. Conducted

claim research. Helped spearhead a recontracting project of over 4000 area physicians.

Kindel Dermatology

Cincinnati, Oh

Medical Assistant, November, 1994-March, 1998

Responsibilities included acting as main surgical assistant to two physicians in a high volume, fast paced

dermatology practice.

Responsible for educating patients and training staff.

EDUCATION: Associate Degree, Medical Assistant

Northwestern College, Lima, Oh-

ADDITIONAL EXPERIENCE, KNOWLEDGE AND SKILLS

• Medicare Risk Adjustment (MRA)

• Comprehensive Primary Care Initiative (CPCI)

• Healthcare Effectiveness Data and Information Set (HEDIS)

• Centers for Medicare and Medicaid Services (CMS)

• Proficient in Excel, Word, Access, CAS, EMPI, PAAG, CGX

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