Project Management Manager
Resume:
Brett Goins
*********@***.*** Phone: 865-***-****
Objective and profile
I am seeking a Network Contract Management position that will utilize my analytical and communication skills and foster personal and professional growth. I am a high energy, enthusiastic worker, who focuses on both specific objectives and company goals. I am comfortable working independently or within teams. I believe my tenacious work ethic and valuable corporate experience will be a great fit at any company.
WORK EXPERIENCE
June 2015 – Present UnitedHealth Group Knoxville, TN Contract Management Expert
Project Management role responsible for moving contracts from Negotiation status to Contract Implementation for 350+ facilities annually.
Manage the timeliness of contract negotiation and contract loading for New Agreements, Amendments, Rate Escalators and Charge Master contracting events for Commercial, Medicare and Medicaid products.
Coordination with Network Managers and Implementation Specialists in regards to end-to-end contract maintenance and loading.
Review contracts for any non-standard terms that could result in loading issues.
Contract review/analysis for any variations to CMS contracting guidelines.
Recommend contract language alterations and modifications to contract negotiators.
Serve as a procedural and systems expert for contract negotiators.
System Demographic Maintenance for Commercial, Medicare and Medicaid systems.
Responsible for the calculation and creation of new contract Appendices and rates for annual facility contract rate increases, Medicare FIRLs, Medicaid State Regulated Rate increases and charge master increases.
Credentialing verification and oversight.
Collaborate with pricing department on more complex contract rate adjustments.
June 2012 – June 2015 UnitedHealth Group Knoxville, TN
Provider Contract Installation Specialist
Performed root cause analysis on the contract loading of Commercial products in NDB/ppoONE for the production environment.
Project management experience through coordinating groups in order to complete large audits on Tier 1 Hospital Systems.
Analyzed provider contracts for any issues that may have affected reimbursement.
Performed quality reviews on facility systems to eliminate waste, fraud and abuse.
Reviewed claim testing to resolve any loading errors before contracts went into effect.
Communicated system load recommendations in a clear and organized manner.
Worked part-time resolving co-worker system issues via the department helpdesk.
Resolved system issues and performed routine maintenance in order for successful claims testing in the HPM environment.
April 2005 - June 2012 OptumInsight Knoxville, TN
Senior Recovery/Resolution Representative
Audited claims processing between healthcare providers and insurance companies through root cause analysis.
Analyzed and Resolved problem accounts for hospitals through contract interpretation, billing errors, database analysis, coordination of benefits determination and data mining.
Facilitated the recovery of health insurance overpayments.
Communicated overpayment trends to hospital business office managers, directors, and CFOs.
Collaborated with hospital accounting departments to resolve revenue cycle miscues.
Built client relationships and networked for OptumInsight.
ACCOMPLISHMENTS
Accepted monthly awards bonus (Roadrunner) for exceeding production/quality metrics for six of the eight months bonus was available in 2013 (UHG).
Received a quarterly Spot Award for outstanding performance in Q3 of 2013 (UHG).
Promoted to department helpdesk after 8 months in my position - February 2013 (UHG).
Achieved a 100% quality score from October of 2012 to June 2015 (UHG).
Maintained an overall quality score above 95% from 2009 - 2012 (Optum).
Managed monthly Account Receivables totaling $200,000+ (Optum).
Resolved $500,000+ in problem accounts for hospitals each month (Optum).
Responsible for the recovery of over $150,000+ in client refunds on a monthly basis (Optum).
SOFTWARE SKILLS
Proficient in: Microsoft Word, Excel, Power Point and Access
Software skill set includes: AS400, Healthquest, IDX Groupcast, Sharepoint, Emptoris, NDB, ppoONE, HPM
EDUCATION
1999 - 2002 University of Tennessee Knoxville, TN
Bachelor of Science in Education
Major: Sport Management
Minor: Business
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