Manager Health

M A R I S SA FERNANDEZ

PROFESSIONAL PROFILE

Inno vative Heal th Care Prof essi on al wit h a b ackgroun d in Pay er

Reimbursement, Contract Negotiations and Audit/Reconciliation for Health Plans,

Networks, Multi Practices, and Billing Departments with an emphasis on leadership and

growth.

EXPERIENCE

August 2013 to Current Saint Mary’s Health Plans

Contracting Manager

• Develop the provider network (physicians, hospitals, ancillary

groups, and vendors) to provide for broad access to a stable network

of high quality and cost efficient providers.

• Evaluate and negotiate contracts in compliance with contract and

other key process controls.

• Establish and maintain strong business relationships with providers

and ensuring that the network composition includes an appropriate

distribution of provider specialties.

March 2011 to July 2013 Saint Mary’s Health Plans

Contracting Specialist

• Responsible for working collaboratively with the VP, Provider

Services, the Contracting Specialist carries out all network

development and contract management activities.

• These actives include: Strategic network development, network

analysis, initial provider recruitment, provide re contracting, and

contract management. The Contracting Specialist will be

responsible for completion of reporting and maintaining a

comprehensive network.

• Review the financial impact of new provider contracts; analyze

impact of change in existing provider contracts.

March 2008 March 2011 Nevada Preferred Healthcare Providers

Formerly Universal Health Network Reno, NV

Provider Relations Representative

• Liaison between UHN and health care providers for purposes

of recruiting, contracting, retaining, evaluating,

maintaining and supporting UHN networks.

• Analyze, monitor and modify the provider contracts to

appropriate fee schedules.

• Negotiate and re negotiate rates based on thorough

analysis of network to insure consistent competitive rates.

Interact as primary contact to the provider community

•

consisting of primary and specialty physicians and their

staff to identify concerns and provide necessary training

and continuing education.

Develop maintain and monitor provider network products

•

(PPO, EPO, Worker's Comp, Medicare) for in network

usages, provider adequacy by specialties and service area, the

most competitive fee schedule attainable to insure

competitive rates based on the current Nevada market trends.

Identify network gaps and recruit qualified providers in

•

accordance with client/payor/network needs. Recruitment

initiatives to include mailings, follow up and tracking of

results.

Detail oriented and knowledge of various fee schedule

•

methodologies, including but not limited to CRVS,

RBRVS, per diems and global discounts

Gallup Q 12 Representative for Universal Health

•

Network. I facilitate all impact planning sessions and ensure the

employee engagement is linked to our business outcomes

such as retention, productivity, profitability, customer

engagement, and safety.

BILINGUAL

Spanish

1134 Lucerne Way Incline Village NV 89451 775-***-****

Contact this candidate