Medical Sales

DEBRA COLLINS

[pic]

**** ******** **** ***** 240-***-****

Frederick, Maryland 21704

abif2r@r.postjobfree.com

Executive Profile

Senior executive with expertise in the health care industry in the areas of

strategic planning, payer relations, network development, provider

relations, operational solutions, and consultative support.

. Directed provider contracting, provider relations, provider

operations, and quality & analytics functions on a regional basis for

the nation's largest commercial integrated model HMO

. Managed all provider contracting functions for a three state region

for a diversified national commercial insurance corporation

. Managed all facets of contracting, network development, provider

relations, provider services, and provider maintenance for a

government-sponsored Medicaid HMO covering forty-three Ohio counties

. Developed a Medicare Advantage Special Needs Plan network resulting in

CMS approval in thirty Ohio counties

. Experienced in negotiating a full spectrum of provider contracts,

including complex integrated delivery systems, PHOs, multispecialty

physician groups, and ancillary providers

. Generated annual strategic plans and budgets in both provider and

payer environments

Professional experience

BENEFITNESS, LLC

Owner 2010-Present

From the inception of the LLC in 2000 to October 2010, provided strategic

direction, developed business models, and designed all collateral materials

for the organization, which historically offered life, disability, medical,

dental, and vision benefits to professional practices and small businesses.

In October of 2010, established a consulting division to support medical

practices by enhancing third-party reimbursement through proven expertise

in contract negotiation, increased market share penetration, and the

development of strategies to streamline operations and increase

efficiencies.

KAISER PERMANENTE 2008-2010

Executive Director, Provider Affairs

Directed Provider Contracting, Provider Relations, Provider Operations,

Project Management, and Financial Analysis functions for the nation's

largest integrated model HMO. Implements key strategic initiatives in

support Kaiser Permanente's products, provider cost structure, network

strategy development and implementation, and provider data integrity for

the mid-Atlantic region comprised of Maryland, Virginia, and the District

of Columbia serving 500,000 members. Collaborated with the Kaiser

Permanente Medical Group to develop a coordinated approach to network

development and the management of external contractual relationships.

Monitored contracts performance to assure alignment with financial

objectives and regulatory compliance across all jurisdictions.

Key Achievements:

> Led comprehensive reorganization of department, revising and rebasing

all job descriptions, realigning functional areas, and implementing

cross-training of staff

> Created 200 Policies and Procedures, workflows, and desk level

protocols

> Established performance metrics and dashboards for each Provider

Affairs functional area

> Implemented QA audit of all rate configuration, provider demographics,

and fee schedule loads

> Negotiated hospital contracts that yielded annual medical expense

savings of $20 MM

> Implemented a utilization steerage program to reduce medical expense

and improve patient outcomes

> Initiated a network right-sizing project that resulted in greater

delivery system service integration

> Implemented contract management and modeling program

CENTENE CORPORATION 2004-2008

Vice President, Provider Affairs

Responsible for overseeing all facets of network development, provider

relations, provider services, provider maintenance, and claims support

services for Buckeye Community Health Plan, a subsidiary of Centene

Corporation operating a Medicaid HMO and Medicare Special Needs Plan in

Ohio. Scope of oversight included four direct reports and forty line

staff. Key contracting metrics included network development aligned with

State guidelines, achieving Health Benefit Ratio targets, negotiating

contract terms that supported medical expense reduction and membership

growth, and functioning as the relationship owner for mission critical

providers. Within the provider relations, provider services, provider data

management, and claims departments, responsibilities included the

establishment and monitoring of performance metrics, escalated provider

issue management, and leveraging corporate resources to improve service

levels across all functional areas.

Key Achievements:

> Led a team of employees and consultants to successfully develop a

statewide network of 120 hospitals, 3,000 physicians, 500 ancillary

providers in a 90 day period to meet State RFA deadline

> Monitored key contracts, renegotiating and implementing gold card and

rightsizing strategies as appropriate

> Successfully executed 25 physician risk contracts in historically risk-

averse markets

> Coordinated network development activities across all Centene

subsidiaries and third party entities in the areas of behavioral

health, pharmacy benefit management, dental, and vision services to

meet State network requirements

> Established Provider Relations monthly call targets and improved

provider satisfaction by 10%

> Established Provider Services performance metrics, restructured call

center, and improved average speed of answer from 12 minutes to < 30

seconds

> Established Provider Maintenance performance standards; implemented

user acceptance testing and improved loading accuracy to > 90%

CIGNA CORPORATION 2000-2004

Director of Provider Contracting

Responsible for all provider contracting and network development functions

for a regional network. Scope of oversight included a staff of eight

direct reports and eight line staff. Market lead for negotiation of

contracts with hospital systems, PHOs, ancillary providers, and physicians,

including financial risk arrangements and fee schedule development.

Responsible for document review and regulatory compliance of executed

contracts. Key metrics included maintaining network integrity, medical

expense reduction, legislative compliance, and the development of provider

partnership programs.

Key Achievements:

> Developed a comprehensive central Ohio network in six months,

resulting in expanded responsibilities for all Contracting and

Provider Relations functions in Ohio, Pennsylvania, and West Virginia

> Led the Ohio Contracting team in the "Transformation" project -

migrating from multiple claims platforms to one comprehensive system

> Coordinated with IT in the development of a contract modeling tool

that supported consistent achievement of contracting unit cost targets

SELECT MEDICAL CORPORATION 1995-2000

Director of Business Development

Responsible for all strategic planning and business development functions

for four long term acute care hospitals. Responsibilities included business

plan development and implementation, start-up staff recruitment, budget

preparation, supervision of marketing personnel, collateral material

development, advertising initiatives, physician recruitment, and all

contracting and network development functions.

Key Achievements:

> Executed all managed care contracts for this first long term acute

care hospital in central Ohio within six months, achieving network

status with all key commercial and public sector payers prior to go-

live

> Led all aspects of the facility build out, managed contracting and

provider relations staff hiring/training, and recruited all Medical

Directors

> Developed collateral materials and a comprehensive marketing plan

CORAM HEALTHCARE CORPORATION 1993-1995

Area Sales Manager

Responsible for all facets of marketing infusion services in the home care

and ambulatory environments. Duties included business plan development,

new product introduction, coordination of disease-specific protocols,

supervision of marketing personnel, and managed care contracting.

Key Achievements:

> Took true start up company from anonymity to $4MM in annual revenues

during two year tenure

> Was recognized as national sales leader both years during my tenure

> Achieved remarkable outcomes for Coram cancer and AIDS patients by

coordinating disease specific trials with prominent Harvard surgeon

PEDIATRIC SERVICES OF AMERICA 1991-1993

Regional Marketing Representative

Conducted market research and operationalized new territory expansion

promoting services throughout Ohio related to pediatric home nursing,

infusion, and respiratory therapy. Managed an account base of

neonatologists, pediatricians, pediatric clinicians, and payers.

Negotiated provider contracts and developed all collateral materials.

Key Achievements:

> Established a central Ohio operation for this new entrant in the

market, developing comprehensive business and marketing plans

> Negotiated a contracts with all key commercial and public sector

payers

ABBOTT LABORATORIES 1989-1991

Medical Nutritional Representative

Responsible for full account management for the marketing disease-specific

enteral formulas, PEG tubes, and pumps. Managed an account base comprised

of dieticians, hospital nutrition support teams, gastroenterologists,

pulmnologists, and other specialty physicians. Negotiated contracts with

hospitals and drug wholesalers.

Key Achievements:

> Consistently recognized as top performer in product line sales

> Featured author of sales strategy articles featured in Abbot's

international journal

> After one year tenure, assumed training role for new employees

Education

. Ohio State University: Master, Study of Law (two years, transferring

to George Washington University)

. Franklin University: Master, Business Administration, Summa cum Laude

. Franklin University: Bachelor of Science, Health Services

Administration, Summa cum Laude

. Miami University: Four years undergraduate work in

Journalism/Linguistics toward a Bachelor of Arts degree

References

Available upon request

Contact this candidate