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Sales Manager

Location:
Fort Worth, Texas, 76102, United States
Posted:
March 29, 2011

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Joan E. Swope, MHS

***** ***** ***** #****

Addison, TX (Dallas Metro)

817-***-****

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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