Mona Lisa S. Webb
**** ******* **** ****** ************, FL 32222
Contact Number: 904-***-**** email: ac6zai@r.postjobfree.com
HEALTH CARE ADMINISTRATION
Profile
An outstanding healthcare professional offering versatile experience within the area of Health Care Administration that will allow me to demonstrate skills, abilities with over 20 years of proven experience achieving performance goals and meeting regulatory requirements with growth and advancement opportunities.
Summary of Qualifications
Exceptional ability to motivate, develop, and direct people as they work while identifying the best job fit for maximum
performance and teamwork
Strong oral and writing skills
Solid ability to interact effectively with personnel in all levels of employment
Skilled in the application and utilization of the SWOT analysis method (Strengths, Weaknesses, Opportunities, Threats)
Results oriented sales and marketing experience
Professional Experience
Humana Healthcare Plans- Jacksonville, FL September 2015- Present Provider Network Operations Executive
Develops and manages provider contracting efforts and partnerships to achieve quality, cost management, and
strategic business development objectives.
Travel throughout the region meeting with providers to discuss current quality performance measures, STAR
ratings, HEDIS scores, review and implement possible process improvement plans to improve quality performance.
Provider Network build and expansion for all lines of business to meet network adequacy requirements for CMS
and AHCA.
Identified & Negotiated through contract efforts that resulted in $589K in cost savings.
Manage the negotiation, renegotiation and administration of all contracts, amendments, Letters of Agreements
(LOA) an addendum within and assigned region with a primary focus on reducing and mitigating delivery and
contractual risks associated with the services being provided
Manage and liaison for MSO’s group throughout certain regions
Contribute to the development and use of provider marketing and training materials assuring compliance with all
state, federal, and product guidelines in new and existing markets
Ensures networks adequacy and cost effectiveness in accordance with established minimum standards
Managed and grew the provider network development department by implementing key workflow strategies
Develops and communicates operational methodologies and best practices to improve employee engagement and
service to patients
Oversee department operations, recruiting, training, supervising and appraising staff
WellCare Health Plans, Inc. -Jacksonville, FL March 2014-Septemeber 2015
Provider Relations/Provider Contracting Team Lead
Work to improve efficiency and quality in delivering healthcare services
Manages physician network by developing and maintaining relationships to drive business results within a specific
geographic area. Provides service and education to network physicians/providers. Achieves company targets through
implementation of Network Improvement plans
Assists in network development and provider service functions for hospitals and selected ancillary providers within
a state(s).
Daily travel to provider offices, conducting site visits to service providers, resolve issues, educate staff/providers on
policies, collect credentialing information, and review HEDIS information.
Performs contract administration including working with corporate on market specific templates, maintaining local
files and documentation, ensuring LOA's are converted to contracts, and meeting GEOACCESS requirements for LOB's
Assist in preparation and execution of periodic contract escalators/amendments and changes related to all lines of
business, also ensure all contracts/amendments meet regulatory guidelines for all products
Through strategic negotiated efforts saved WellCare over 1.2 Million dollars
Project lead on HEDIS reports distributions for all Provider Relations Representatives
Jones College – Jacksonville, FL March 2012 – March 2014
Director of Operations
Oversee all current students, graduates, alumni’s and departmental staff
Managed, Oversee and responsible for the Career Development Department at two college campuses
Implemented policies and procedures that update and improve placement services on campus in
accordance with ACICS and College directives
Conduct in-class and outside-class workshops coaching students on resumes and interview skills
Perform quality audits for accuracy
Prepared employee reviews, annual evaluations and departmental training
Provide operational supervision to staffed employee
Responsible for hosting quarterly job fair events, recruiting, interviewing and hiring employees
Bank of America – Jacksonville, FL July 2010 – January 2012
Customer Relations Manager
Interviewed customers for modification eligibility options based on their current hardship status
Analyzed customer application and financial documents to determine modification approval
Perform audits on loan files for accuracy according to current guidelines
Perform underwritten procedures on loan files based on signing authority
Created payment options to bring account within good standing
Provided feedback and coaching to internal and external employees and customers
Operate in a call center environment setting
Blue Cross and Blue Shield/Florida Blue – Jacksonville, FL January 2000 – June 2010
Provider Services Operations Team Lead
Analyzed and audited health care claims processed through system automation
Reprocessed claims for payment accuracy that rejected via system automation
Created and preformed audits on cost reports for various lines of business
Updated provider contracts and fee schedules based on the contractual agreement
Contact providers and third parties to discuss overpayment claim and request refund
Review and audit customer account status
Perform credentialing reviews for new and existing providers
Claims Project Manager for top ten health care providers
Contacted providers and suppliers for missing claim information needed to process medical claims
Work closely with home plans on provider projects for out of state providers
Subject Matter Expert and trained new employees and provided coaching and feed back
Call Center Team Leader
EDUCATION
Rasmussen University Currently Attending
Bachelors of Science Health Care Management
Jones College December 2002
Associate of Science Business Administration
References available upon request