Sales Customer Service

KAREN ROBINS

**** ******* ***** **** *****, TX

*8645

Home: 512-***-****

Mobile: 512-***-****

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Skills Profile

Tenured health care professional with demonstrated skills in:

. Contracts negotiation, implementation, administration, compliance

. Complex claims resolution

. Business referral development; development of strategic marketing

programs to promote branding alliances

. Consultative sales; key account management & retention

. Effective communication skills targeted to a wide variety of

audiences/clients

. Public presentations (utilizing various media); staff development

. Database management & input; report generation; financial analyses

EDUCATION: BA, Augusta State University, Augusta, GA

Professional Experience

HEALTHTRONICS, Austin, TX 2003 - 2010

Contracts Administrator; Responsibilities Included:

. Negotiation & administration of health care contracts nationwide

inclusive of Medicare, Medicaid, 3rd Party Payor, hospital,

managed care, government, laboratory, medical equipment

(warranties, medical devices)

. Resolving complex claims issues & submitting appeals;

. Ensuring contract compliance within state/federal/internal

guidelines

. Database management, report generation, & reimbursement analyses

utilizing various software programs

. Daily interaction & communication with internal departments

(Finance, Legal, CBO, Credentialing, Operations), Area Vice

Presidents, Sales personnel, & external clients (hospital personnel

- physicians, CEO's, business office managers; managed care & 3rd

Party Payor representatives)

COMMUNITY PARTNERSHIP OF SOUTHERN ARIZONA (CPSA), Tucson, AZ 2002 - 2003

Contracts Representative; Responsibilities Included:

. Development & administration of behavioral health provider network

contracts for CPSA - one of the Regional Behavioral Health

Authorities for the State of Arizona

. Monitoring compliance with contract terms & conditions - including

credentialing, provider registration, & deliverables

. Providing technical assistance to individual contractors/provider

networks as requested

. Coordination of & participation in monthly provider meetings

HEALTH 'N' HOME (an Albertsons company), Tucson, AZ 2000 -

2002

Product Offerings: DME, O&P, Rehab, Respiratory, Infusion Therapy

Referral Development Coordinator; Responsibilities Included:

. Business referral development targeting the Tucson medical

community - physician offices, physician-based organizations,

hospitals, health care facilities & organizations, at-large

community; conducted on-site presentations in order to promote

product education & reimbursement guidelines

. Initiation & implementation of contracts with managed care

providers, health-related associations, & government-funded

organizations to increase referrals & to nurture long-term

relationships; sole responsibility for account management,

including resolution of claims & customer service related issues,

collection of outstanding moneys owed, renegotiating of contracts;

utilization review

. Developing & analyzing reporting data to measure referral

effectiveness

KAREN ROBINS

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CIGNA HEALTHCARE OF FLORIDA, Tampa, FL 1995 -1999

Positions Held:

I. Contract Implementation (1998-1999)

Contract review, implementation, & monitoring; lead responsibility for the

development & implementation of several "process-oriented" documents whose

focus was to ensure contract standardization (defining each component of

the contract) & compliance by all parties

Conducted on-site presentations with providers to review contracts,

identify & address

service/benefit/claims issues, review reimbursement methodologies,

review utilization

Development of a reporting process for delegated oversight

Overseeing provider compliance in accordance with guidelines outlined by

Cigna & CMS;

reporting responsibility to ensure correctness of provider agreements

Coordinated & conducted claims audits with external & internal partners for

NCQA accreditation

Initiated & coordinated weekly operational reviews to ensure contract

compliance & to address & resolve contractual and/or service issues

II. Marketing Coordinator, Government Programs (1997-1998)

Developed & implemented strategic alliance partnerships & marketing

programs for Cigna's

Medicare Advantage program

Specific focuses:

1)Provider Marketing:

Responsible for the design & implementation of Cigna's strategic marketing

process for network providers

Created & conducted marketing presentations to hospital boards & provider-

based organizations to support "buy-in" of the marketing program for the

purpose of fostering partnerships & expanding client bases; developed a

provider speaker's forum

Developed detailed reporting analyses to measure program effectiveness

Conceived, developed, & authored Cigna's first Provider Marketing Manual,

providing a step-by-step "how-to" in designing, budgeting, & implementing

strategic marketing plans for providers; this manual served as the

benchmark for provider marketing programs corporate-wide

2)Event Marketing:

Determined sales opportunities utilizing cost-benefit analyses & developed

target market promotions based on market demographics

Developed & implemented Cigna's Broker Referral Program (working with

external insurance companies)

Developed tracking & evaluation systems used to analyze the impact &

effectiveness of marketing efforts, budgeting, & resultant lead generation

leading to sales

Designed various advertising collateral negotiating directly with outside

vendors for pricing & delivery; lead responsibility for ensuring HCFA

compliance with all marketing & advertising material (this required a

rewrite & redesign of all marketing collateral); served as spokesperson in

radio, television, and community marketing campaigns

III. Benefit Representative, Government Programs (1995-1997)

Presented Cigna's Medicare Advantage program to Medicare-entitled

beneficiaries through one-on-one & group presentations; utilized a

consultative selling approach to increase sales; achieved the highest

enrollment number in a 1-month period & consistently maintained the

highest member retention percentage

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