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Manager Service

Location:
Jacksonville, FL
Salary:
125,000
Posted:
September 08, 2018

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Resume:

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



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