Tiffany Whitney

**** ****** **** ************, ** 46254

Cell: 317-***-**** Email: ac0bo6@r.postjobfree.com

EXPERIENCED NETWORK DEVELOPMENT AND CONTRACT MANAGER

Contribute to an ethical, character-driven progressive and innovative organization that desires a competitive negotiator, innovative recruiter, and proactive business development manager with commercial, government, domestic and international experience.

Recruiting, Negotiating & Closing

Price Analysis& Benchmarking

Data & Root Cause Analysis

Strategic Planning & Development

Contract & Change Management

Compliance & Regulations

PROFESSIONAL EXPERIENCE

Humana Inc.

Provider Relations Consultant

April 2013- Present

Assist vendors, providers and Humana market offices with questions related to billing for hospital bill audits, specialty audits, DRG audits, and SNF audits

Develop audit tools and conduct reviews at providers’ offices

Liaison between multiple business partners to identify and resolve problems and concerns

Build a greater understanding of disclosure requirements for information about code editing logic through claims and billing expertise

Triage assignment based on urgency, importance, risk assessment, access and cost-saving

Volunteer to assist Clinical Utilization Review with the Intake of Medical Records for Prior Authorizations, Pre-Certifications, Reviews and Appeals

JJW Enterprises, LLC –A Cost-Containment Company

Principal

November 2010 – April 2013

Create, manage and plan products, processes, procedures, structure of company, marketing, accounting, purchasing, budgeting, manage all projects and contracts, hiring, goals, target markets and vision

Analyze business and legal issues and handle according to company’s goals, vision and plan

Write and review all documents-- internally and externally

Claims administration operations, case management, pricing analysis and bill review

Negotiate--Proactively, Concurrent, Retroactively

Recruiting, negotiation and contracting health care providers and facilities and claims processing

Bill review, case management and cost-containment

New business enterprise development and marketing services for TPAs, Self-Funded and Insurance Companies

International Medical Group (IMG)

International Network Development Manager

February 2011 – January 2012

Created a Cost-Savings $3.6M through negotiations of both domestic and international with an average savings 42% and a 73% savings on a $600 M in domestic claim

Identified, recruited, negotiated, contracted/re-contracted and implemented International Providers (136 twenty-seven of the providers are located in countries in which they never had access), Networks (12 4 in countries that they never had any access) and Assist Companies (4 two in countries in which they never had access)

Developed all provider communication and educating for participating and non-participating providers, networks and assist companies

Acted as liaison between IMG and all participating and non-participating US and International providers, networks and/or assist companies to resolve any issue related to access, contracts and or participation Maintained, updated, and edited provider database

Aetna Insurance Company

Contract Negotiator

September 2009- August 2010

Negotiated, re-negotiated and executed physician, facility and ancillary provider contracts (100% Evergreen)

Initiated legal reviews as needed; ensure all required reviews completed by appropriate functional areas

Met contracting/recruitment targets within defined financial metrics.

Seven Corners

Network Development/Provider Relations Manager

June 2008- September 2009

March 2008 – June 2008 Aerotek Account Manager –Temporary to Permanent

Identified, recruited and negotiated/renegotiated contracts (Evergreen and Term) with hospitals, physicians and ancillary providers and facilities for government in response to RFPs and commercial business

Reviewed, analyzed and advised on RFI, RFQ, and RFP for business risk including financial, performance –accountability, control and resources--statement of work (SOW), indemnification, reputational/risk mitigation

Recruited, interviewed, and hired on-site providers for various correctional facilities and procured services in relationship to the health service contract in accordance to the FAR and OOC

Facilitated all communications between facility and provider community

Initiated and finalized all provider appeals contracted FDC Houston for a five year award worth $1.5M

Solely contracted providers for FCC Coleman, five-year contract $800M

Bill negotiations front-end and back-end with savings of 76% of billed charges for government and commercial policies

Identified, marketed and recruited new business through trade-shows and cold-calling

Indiana Business College, Indianapolis, IN

January 2007 to March 2008

Insurance/Medical Billing and Coding Instructor

Created instructional design and taught Basic & Advanced Insurance, Procedural & Diagnostic Coding, Medical Billing, Medical Records and Health Information Technology

MDWise Hoosier Alliance, Indianapolis, IN

Provider Relations Specialist

December 2006 to March 2007

Negotiated ancillary, PMP and Specialist contracts

Conducted in-services and office staff education

Resolved claims, checks and provider/facility system set-up issues

Temporary Avenue--Managed Health Services, Indianapolis, IN

CONTRACT NEGOTIATOR

September 2006 to November 30, 2006

Prepared, negotiated and delivered contracts, credentialing packets and site-visits surveys

Recruited and performed Provider Relations/Education

Hamilton’s Health Aid Services, Indianapolis, IN

COMPLIANCE OFFICER

November 2005 to May 2006

Negotiated and contracted --TriCare, Aetna, United Health Care, Molina, Managed Health Services, Anthem, Cigna, PacifiCare and Humana

Prepared documents and rebuttals for Indiana and Ohio Medicaid Audits

Instructed employees on policy(HIPPA, Medicare, Medicare), procedures and payment processes

Attended AIMES, Indiana Medicaid and Medicare meetings, seminars and conferences

EDUCATION

Indiana University, Bloomington, IN; B.A. English and Secondary Education

CERTIFICATION

Indiana Notary Public Commission Number: 630916 Liberty Mutual Bond Number: 32S352555

TECHNICAL SKILLS

Microsoft Office, MS Access, PeopleSoft, SAP, CGX

Contact this candidate