Managed Care Executive
Resume:
Sarah Jordan
Douglasville, GA 30135
Objective
To obtain a position where I can utilize my 9 years of Managed Care, Provider Relations, and Contracting experience to benefit your organization and further my career.
Professional Experience
Manager, Network Development, WellCare of Georgia
October 2007 to current
• Hired, trained, and manage a team of Network Development Representatives to efficiently contract with providers throughout the state of Georgia for our Medicaid line of business
• Analyze current contracts to find ways to reduce costs, while maintaining access for our 485,000 plus members.
• Work directly with Senior Management to target and negotiate contracts with key providers.
• Handle all GeoAccess reporting and auditing for Department of Community Health.
• Point of contact for Department of Community Health for all access issues.
• Responsible for reviewing WellCare's contract with the State of Georgia and Department of Community Health to ensure our contract templates are in compliance with all Federal and State regulations.
• Built policies and step action tables to ensure we are in compliance and have documentation to prove compliance with the State of Georgia.
• Build and maintain relationships with key providers.
• Help build networks according to HSD tables for Medicare Advantage products.
• Received 100% on the Network Development portion of the EQRO audit.
• Assisted Quality department in receiving accreditation through NCQA.
• Manage Physician and Ancillary contracts across the State of Georgia.
Senior Contracting Specialist, Coventry Health Care
February 2007 to October 2007
• Consolidated contracts with large IPAs, PHOs, and Hospitals
• Contracting point person for Emory, Floyd Medical Center, Tenet Hospitals, Gordon Hospital, Wellstar, The Childrens Health Network, other North Georgia and Southeast Alabama Hospitals and large groups.
• Special projects for highly needed providers
Contract Negotiator, Centene Corporation- Peach State Health Plan
Provider Relations Specialist, Centene Corporation- Buckeye Community Health Plan/Peach State Health Plan
March 2005 to February 2007
• Assisted with the implementation of Buckeye Community Health Plan in Summit County, Ohio and with the implementation of Peach State Health Plan in the Georgia market.
• Oriented and educated all assigned providers.
• Organized and implemented monthly meetings with Summa Health System and other large groups to resolve claims and authorization issues.
• Handled all issues that providers had regarding our policies, claims and change over from SummaCare Medicaid.
• Handled all large presentations for Provider Relations
• Point person for the Children's Health Network (TCHN), Dekalb Medical Center, Wellstar, Gwinnett PHO and CAAP.
• Negotiated contracts with large PHOs/IPAs, ancillary providers, ambulatory surgery centers, hospitals, and physicians.
• Handled all TCHN Provider loading issues and audits.
Provider Relations, SummaCare
August 2001 to March 2005
• Assisted Provider Relations with all provider issues.
• Handled all reporting to Senior Management regarding providers visited and audited.
• Created Provider Relations section on the intranet.
• Handled all reporting for NCQA and ODJFS.
• Coordinated all SummaCare direct contracts and followed through until approved by Credentialing. I was the first point of contact for all interested providers.
• Handled all mailings to providers. Coordinated and set up all Provider Seminars.
• Ran Crystal reports and created Access database for providers.
• Was a team leader in the Provider Service call center. Trained and helped supervise the new Provider Service Representatives by auditing phone calls and phone logs.
Account Executive, The Review Times
February 1998 to May 1999
• Sold advertising space to businesses for local newspaper.
• Took advertisements from design to print.
• Worked with local businesses in designing advertising budgets, and collected on past due payments.
Secretary, Fostoria Community Hospital
May 1997 to February 1998
• Assisted Marketing Manager with foundation work.
• Assisted Human Resource Manager with filing employee files, and worked in database to enter employees and foundation donors.
• Helped supervise volunteers and set up scheduling for hospital receptionists.
Education
Ashford University Bachelors of Art in Organizational Management with a minor in Sociology
Skills
Microsoft Word, Excel, Access, Powerpoint, Project, Amisys, Crystal Reports, Cypress Reports, ACT, Macess, Sidewinder, Peradigm, Omniflow
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