Sales Manager
Resume:
Joan E. Swope, MHS
Addison, TX (Dallas Metro)
Profile - http://www.linkedin.com/pub/joan-swope/b/335/8b6
MANAGED CARE/BUSINESS DEVELOPMENT & Contracting
Career Summary: 15+ yrs Consultative sales and business
development/contracting experience in managed care, Pharma and hospital
system solutions. Medicare/Medicaid expertise. "C" Level Suite national
rolodex.
NATIONAL PANEL MEMBER: The Health Plan Forum on Medicaid Expansion &
Health Benefit Exchanges: Reaching, Servicing, and Retaining the New
Enrollee Population, San Francisco, July 17-18, 2011.
EXPERIENCE
CURRENT: Consultant, Medicaid Expansion/Provider Contracting Project,
UNITED HEALTH GROUP, TX Plan.
AMERIGROUP CORPORATION, Medicare Advantage, Medicaid and Healthy Kids
Program, Interim Director of Provider Relations & Contracting, Tampa, FL.
. Reporting Team of managers and provider contracting reps, including
offices in Orlando, Tampa and Miami.
. Responsible for Behavioral Health and Support Services team of
contractors for physicians statewide.
. Physician Relations/Physician Contracting statewide, including service
issues, claims and ongoing Single Case Agreements.
. Partnering on IPA and Hospital/PHO team negotiating Provider Networks
across FL.
. Responsible for Credentialing/recredentialing team across State of FL.
2007 - 2010: UNIVERSAL AMERICAN, ManagedCare Regional Provider
Relations/Contracting- Medicare Advantage Products, and Agent/Broker
Liason. DFW and KC locations.
. Contracting/negotiations with providers/hospital systems and
ancillary providers across several states.
. Sales presentations to Union stewards for Medicare coverage in
Midwest.
. Keen knowledge of revenue cycle reimbursement issues for hospital
systems, and provider groups.
. Negotiated successful large IPA contract (over 150 physicians): HMO
(added to PPO/PFFS), 2010, Kansas City. Also, six new provider
contracts in Adams County, MS, during first qtr 2010.
. Implementation manager, educating PPO networks in multiple states
after contracting efforts; Provider presentations/ PPO roll-out to
Uninet/ Alegent Healthcare System/NE.
. Daily trouble-shooting/resolution of claims problems, billing, member
issues, and medical/care management issues; includes referral
negotiations to home health, LTC/Nursing home facilities.
. Expert in Facets Claims system, Netsuite CRM database and HIPAA regs.
. Daily resolution of complex reimbursement issues for Medicare, Part D
and Coordination of Benefits.
. Part B vs. Part D knowledge/negotiations, especially in chronic
conditions, such as oncology. Specifically work with U.S. Oncology and
Rocky Mountain Cancer Centers for agreements/claims.
. Market Expansion/business development across South Central US for
PPO/HMO managed networks, including Nebraska, Montana, Colorado,
Missouri, Mississippi, and Texas.
. Training/recertification of Sales Reps annually; new PR reps across
mid-central region.
. Support/troubleshooter for sales agents and brokers claims, billing
issues across South Central US.
. Introduction/training of new Provider Portal to physician and hospital
practice offices, N. TX.
2005-2006: UNITED HEALTH GROUP, Sr. Network Account Manager, KC Plan.
. Provider contracting across rural Kansas for health plan.
2004-2005: VENTIV Pharmaceuticals, Therapeutic Area Specialist; RAM,1-year
Contract. KC /CA.
. Brought new Co. to US! Selling SSRI therapies to physicians/clinics
in KC and one of three specialists chosen to perform Santa Barbara
Managed Care Blitz. Top Producer team of 4 in the Nation.
2003-2004: BELL CANADA ENTERPRISES (EMERGIS) : Regional Sales Director,
KC/Rockville, MD.
. Sold National Health Services portfolio of Disease Management, case
management/work comp; National PPO Networks, Fee Negotiation Services
.
. Sold Health Alliance (Physician Owned Health Plan) and Cariten Health
Plan a portfolio of National Provider Network, Centers of Excellence
and EDI repricing solutions. Revenue: $400,000/sale.
. Sold 7 new accounts in one year, average sale $300,000 (3-year
contracts), for $2.2 million.
1999-2003: REGIONAL SALES: eHealthcare for RelayHealth, and
HealthTrio, top producer, CA.
Sold first portal system to Sisters of Mercy Health
System, St. Louis. National Award Winner.
1996-1998: SALICK ONCOLOGY/INFUSX, Director of Marketing/Public
Relations (Staff of 2).KC, KS.
. Business Development Partnerships with Surrounding Regional
Hospitals. Contacts: COO, Directors
1. . Negotiated Consulting Physician Contract for Dr. John Weed, GYN-ONC,
with Kansas City North Hospital, Regional Physician IPA's & Olathe
Medical Center, at CMO level.
2. . Developed a Reciprocal Referral Relationship with Children's Mercy
Hospital to treat Pediatric Oncology patients. Contact: VP of
Marketing.
3. . Posted the first PR Release on KUMC Website, which received
nationwide response, to announce the cutting edge Iridium Seed Implant
Surgery for Prostate Cancer.
4. . Directed first successful Breast Cancer Treatment Symposia, with
over 200 Regional Clinicians and Physicians in attendance.
5. . Marketed 20+ Academic Oncologists in Regional Community Education,
Contracting and Partnership Agreements, 1996-98.
6. . Directed successful Medical Education Symposia, Breast Cancer
Treatments, with 250+ Physician Attendees -Salick Oncology.
. Responsible for 170 page Strategic Marketing Plan for entire Out-
Patient Oncology Center, in partnership with the KU Medical Center
team.
7. . Sold Infusx Home Health Infusion Therapies to MCO's, Case
Managers, Nursing Homes, IDN's & referral doctors in the Region. Top
Regional Producer of Salick System.
8.
1993-1996 : MERCK PHARMACEUTICAL, Regional Account Manager, Managed
Care. KC, KS.
. Began as Graduate School Internship program.
. Above quota (110%) Sales of two therapeutic classes, BPH and C/V
Products.
. Clinical partnership with Deaconess Health, MO and Our Lady of the
Lake, LA.
. PBM sales with Medco team, awarded State of Louisiana Medicaid
contract, 350K members.
. Long term partnership with Zocor closed formulary for Cigna-Allied
Signal Corporation.
. RAM pull-thru activities in South Central Region, focusing on
MCO's, "C" level payor execs, and P & T Committees.
1984 - 1992: Sold Group health plans for HealthCare Plus (became
Cigna) and BCBS of KS. Products included Medicare, HMO, PPO, POS, EPO
and self-funded. Top Regional Producer.
EDUCATION
Master of Health Science - Wichita State/Kansas University, 1993, 3.74
GPA.
Bachelor of Health Science and Registered Dental Hygienist.
Certification, Faculty, University of Phoenix, 2006.
Professional, Academy for HealthCare Management, Graduate 2002
National Speaker: Building Bridges Conference, AAHP Sponsored, Chicago,
2000.
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