Medical Billing Sales

OBJECTIVE

Seeking Key Management position utilizing my skills and background that

will provide an opportunity to enhance the health benefits of those

consumers being service by the organization.

WORK HISTORY

GA Department of Community Health

State Health Benefit Plan (Public Employee Health Benefits Division),

Atlanta, GA

2005 - Present

Responsible for oversight of the healthcare vendors' network management,

provider recruitment, disruption analysis and servicing of the all

providers types

Lead implementation activities supporting benefits designs and strategies

for 700,000 covered lives

Lead initiatives to implement specific activities that support our benefits

designs and strategies

Serve as the primary contact for escalated legislators, member, provider

and vendor administrative issues

Serve as a lead in the evaluation of healthcare vendors based on access,

quality, utilization and financial stability

Served as a lead with designed plan alternatives, contract review, Request

for Proposals (RFP), and overall vendor management

Assisting with implementation of plan changes as well as introducing new

benefits programs

Piedmont Healthcare System, Atlanta, GA

2003 - 2005

Served as the medical billing administrator for the hospitalists group at

Piedmont Mountainside Hospital

Primary contact for all administrative matters for the provider group

Southern Healthcare Consulting, Marietta, GA

2001 - 2003

Responsible for new business development for medical billing services

increased business over $1.5M

Negotiated medical billing contracts with over 25 physicians in Georgia and

Texas that resulted in new business

Participated as a member of the Business Operation Advisory Board

Marketed medical billing services across the U.S to neonatologists,

pediatricians and family practice physicians across the U.S.

GA Department of Community Health

State Health Benefit Plan (Public Employee Health Benefits Division),

Atlanta, GA

2000 - 2001

Responsible for the overall provider network activities of the

implementation and ongoing management for 1st Medical Network for Plan's

statewide PPO initiatives

Identified over $1M of provider payment errors by TPA

Served as a lead in the development of the Request for Proposal (RFP) for

the Plan

Served as a lead in the evaluation of healthcare vendors based on access,

quality, utilization and financial stability

Handle benefits questions from employees and providers oral and written

Vivra, Inc.

1999 - 2001

Managed a staff of 10 employees with services ranging from system updates

on hospitals and physician contracts for 4 specialty networks, such as OB-

Gyn, orthopedics and podiatry in GA and FL

Assisted the sales team with network access and provider disruption

analysis and projected ROI for existing accounts and new business prospects

Managed the credentialing and provider database activities of each network

Principal Healthcare

1997 - 1998

Managed a staff of 10 employees with responsibility for provider network

development and service of physician, hospital and ancillary providers for

HMO and PPO products in GA and FL

Managed the credentialing and provider database activities for over 75,000

physicians and 175 hospitals

Assisted with the sales team of network access and disruption analysis for

new business prospects and existing accounts

Responsible for monitoring HMO and PPO health plan accreditations

PROMINA Northwest Health System

1995 - 1997

Managed a staff of 8 employees with responsibility for credentialing

system, provider updates, provider services for a fully-integrated

healthcare system

Oversight of communication and education on hospital and physician

contracts with managed care organizations such as, Aetna, Blue Cross Blue

Shield, Cigna, Kaiser, PHCS, Medicaid and Medicare

Worked closely with the Medical Director on the PHO credentialing and

contracting activities

GA Baptist Health System

1994 - 1995

Managed a staff of 4 employees with responsibility for system updates,

credentialing, billing issue and provider education on hospitals and

physicians contracts with managed care organizations such as PHCS, Blue

Cross Blue Shield and Medicare Secure Choice

Worked closely with the Medical Director on the PHO credentialing and

contracting activities

Cost Care, Inc.

1991 - 1995

Supervised staff of 6 with responsibility for provider relations functions

such as billing issues, initial provider orientation and ongoing education

for PPO and POS products

Day to day supervisor of internal and external provider relations staff

including data management and credentialing staff

Enhanced service standards that increased services to Fortune 500 companies

inquiries by 65%

. Expanded provider networks in GA, FL, SC, TN, TX and LA

AmeriPlan Health Services

1983 - 1989

. Supervised staff of 6 with responsibility for member and provider

relations functions such as billing issues, initial provider orientation

and ongoing education, and benefit interpretation for HMO plan

. Day to day supervisor of internal and external provider relations staff

including data management and credentialing staff

. Expanded provider network in metro Atlanta, GA and Jacksonville, FL

. Assisted with the sales team with network access analysis for new

business prospects and existing accounts

EDUCATION:

Pickens Technical College

1975 -1977

Kennesaw Junior College

1984 -1985

References Available Upon Request

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