Health Physician

Diamond S adams

Home: *** ********** **. ( Akron, Ohio 44313

330-***-**** mobile ( *.*********@*****.***

Professional Work Experience

. Summa Health Network- Akron, OH 10/2011- Present

Physician Network Representative

. Serve as a liaison between physicians and payers and facilitated all

issue resolutions.

. Assist with the recruiting and credentialing of new providers.

. Coordinate new provider process to include completion of all

application requests, collection of pertinent data and execution of

contracts.

. Established a team-approach with credentialing staff to maintain

provider database integrity and timely completion of the credentialing

process.

. Assure that provider documentation was complete and accurate and that

provider date was entered into the provider database in a timely

manner.

. Send credentialed providers to payers in a timely manner.

. Maintain an accurate and current provider database relating to

provider facilities and physician information.

. Manage internal education of payer policies and procedure updates.

. Draft thorough and concise physician communications, newsletter

articles and correspondence related to Summa Health Network operations

including the Messenger Model, Performance Incentive Model and

Clinical Integration Model.

. Educate offices on Ambulatory Care Model incentive models.

. Research and coordinate the resolution of provider claim and

capitation issues.

. Assist in Accountable Care Organizations projects.

. Facilitate messengers to physicians and served as the main contact.

. Educate offices on payer quality initiatives.

. Coordinate Diabetes Initiatives with offices and serve as the main

contact.

. Publish monthly payer update newsletter.

Summa Health Network- Akron, OH 9/2010-10/2011

Physician Data Analyst

Communicates updated physician information to SHN payers timely and

effectively.

. Ensures data files for new providers and new payers are complete as

appropriate.

. Coordinates educational seminars and webinars for the practice

administrators and quality improvement task force.

. Serve as a primary contact internally and externally regarding SHN

data.

. Maintains electronic medical records database and monthly invoices.

. Educates physician offices on electronic medical records.

. Responsible for physician communications and mailings.

. Efficiently entering credentialed and re-credentialed physicians into

the SHN database.

. Responsible for reporting and data analysis needs as required for SHN

operations including SHN participation models, physician network

activity, and new payer agreements.

. Provider networking through face-to-face interaction with the

physician groups.

Professional Experience:

Summa Health Network: Akron, Ohio, March 2010-June 2010

Internship

. Assisted in Managed Care compliance initiatives (payer report cards

and claim denial research)

. Organized and archived managed care contracts in an electronic

contract management system

. Assisted in developing a managed care "contract language notebook".

. Contributed to the development of a hospital performance presentation

for Payers, using Health Grades information.

. Assisted with the "red lining" of payer agreements in the negotiation

process.

Summa Western Reserve OR Department: Akron, Ohio, November 2009-December

2009

Practicum

. Shadowed Administrator in a number of venues and projects focused on

problem solving and physician relationship building.

. Assisted in the revision of different operational forms.

Future Health Care Administration Group (FHCA): Athens, Ohio, September

2008-Present

. Attended and participated in meetings in which new problems in the

health care were presented and discussed solutions.

. Conducted discussions, and information tables at fairs.

Education:

BS in Health Service Administration: Ohio University, Athens, Ohio, June

2010

Professional Organization and Skills:

Computer Skills

. Efficient in Microsoft Office including Microsoft Access, Microsoft

Excel, Microsoft Outlook, Microsoft Publisher, and Microsoft Visio

. BrainShark

. GoToWebinar

Oral Communication Skills

. Proactively resolve issues and handle requests in a timely manner

. Assist in the development and training of new staff members

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