Manager Health

Cheryl White

Email: abpugc@r.postjobfree.com

Address: ** ****** ******

City: Wallback

State: WV

Zip: 25285

Country: USA

Phone: 304-***-****

Skill Level: Management

Salary Range: $90,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

PERSONAL RESUME

Cheryl A. White

99 French Street

Wallback, WV 25285

304-***-**** (H)

502-***-**** (C)

abpugc@r.postjobfree.com

OBJECTIVE: -To secure a managerial position to fully utilize my skills.

WORK EXPERIENCE

10/11 to Present Coventry Health Care, Inc. Manager, Network Operations

CoventryCares of Kentucky

Responbilities:

* Credentialing Primary Care Physicians, Specialists, Ancilliary and Hospitals

* Contract Implementation of signed contracts received from Network Development

* Reports as required by the Commonwealth of Kentucky, monthly and quarterly

* Network analysis

* Provider maintenance

* Claims analysis/resolutions

* Fee Schedule Updates/Maintenance

* Supports Provider Relations with operational needs

* Supports Contract Management with contract issues

Participates as a member of the following committees:

* Provider Advisory Committee

* Policy and Procedures Committee

* CCKY Quality Committee

* CCKY Social Committee:

9/04 - 10/11 Coventry Health Care, Inc. Sr. Contracting Specialist

Carelink Health Plans

Responsibilities:

* Build a participating network for Medicaid and Commercial lines of business

* Generate reports for network comparison to competitors

* Review contracts and communicate with Legal to ensure compliance

* Contract providers to standard fee schedules based on analysis of prevailing local practice patterns (Counties & specialties) and medical dynamics of multiple locations for cost savings

* Negotiate Physician, Hospital and Ancillary contracts, to include PHOs/IPAs, large multi-specialty groups

* Build a participating network for Home Health to assist Health Services

* Created and implemented a standard form to ensure contracts are loaded appropriately

* Attend Medicaid workshops

* Attend Physician Conferences

* Assist Staff with Credentialing by implementing a form for processing applications to eliminate issues

* Assist Health Services with Out-of-Network referrals by negotiating fees utilizing Letters of Agreement

* Plan designate for building Workers` Compensation network

* Plan designate for building network for Federal Employees Health Benefit (FEHB) business

* Conduct site reviews and on-site training for Plan`s provider portal, Direct Provider and delivery of policies and changes to Plan requirements

* Submit requests/documentation for annual updates of all fee schedules for Medicaid, Commercial and Rental business

* Other duties as assigned

PERSONAL RESUME - CHERYL A. WHITE - Page Two

4/00 - 9/04 MAMSI Sr. Provider Networks Representative

Responsibilities:

* Recruiting healthcare providers for network

* Reconciling claims and reimbursement issues

* Training to individuals and groups on plan`s procedures, and visit in-plan providers for PR.

* Prepare Excel spreadsheets for reimbursement negotiations.

* Credentialing of providers adhering to NCQA guidelines.

OTHER SKILLS:

Proficient in Word, Excel, Power Point and Visio applications. Also utilizes outside sources such as CAQH, NPPES, and Code

Manager

PAST AND PRESENT COMMUNITY AFFILIATIONS:

Tri-State Fil-Am Association of WV, KY, OH

U.S. Naval Sea Cadet Corps, Public Affairs Officer

Keiki O Ka Aina - Polynesian Culture, Publicity Chairman

Wahine O Polynesia, Polynesian Culture, Publicity Chairman

Pageants of Polynesia, Publicity Chairman

State Cultural Resource on Hawaiiana

Habitat for Humanity - Family Support Committee

Kaua`i Alzheimer Connection

Literacy Volunteers of America

American Legion Auxiliary

Contractor`s Association of Kaua`i, Co-Organizer

REFERENCES:

Provided Upon Request

Contact this candidate