NIKKI HALL

832-***-**** ad24ib@r.postjobfree.com

HEALTHCARE PROFESSIONAL

Contract Negotiation Client Relations Employee Relations Executive leader with expertise in all facets of healthcare including Contract Management, Contract Negotiation, Project Management and Controllership in a corporate setting. Skilled in collaborating with multiple departments throughout the organization to achieve business and financial objectives. Instrumental in streamlining and improving processes, enhancing productivity, and implementing strategic solutions. Technical proficiency in MS Office Suite.

● Contract Negotiation

● High-Level Communication

● Strategic Planning/Analysis

● Training

● Team Building

● New Business Development

● Regional Leader

● Management

● Budget Analysis

● Process Development

EDUCATION

BS, Healthcare Administration, Texas Southern University, Houston, TX P R O F E S SI O NA L E X P ER I E NC E

Friday Health Plan, TX

Director of Network and Provider Relations 2021 – 2023

● Drive provider relations and contract performance nationally

● Develop, lead, and execute provider partnerships throughout established markets

● Oversee market contracting and provider relations team nationally

● Execute market-wide provider network plan to align growth and performance

● Negotiate and execute all levels of provider contracts; Pay for Performance, Value Based Contracts, Capitation Agreements and Telemedicine Agreements consistent with organizational goals

● Network development and strategy

● Engagement weekly with written and verbal communication to Vice President of Network and Provider Relations

● Develop internal partnerships to implement and maintain health plan/provider relationship.

● Foster positive, professional relationships with network providers and associated staff.

● Provide ACO network education development and implementation

● Vendor Contract oversite

● Risk Adjustment oversite

● Policy and Procedure Development

● Payment Integrity forecasting

● Mentoring and staff development

Nikki Hall

Texas Children’s Hospital, Houston, TX 2019– 2021

Manager of Provider Relations

● Responsible for general oversight of a Medicaid provider network in the state of Texas comprised of over 4,300 providers, 6,800 specialists and 118 Hospitals.

● Provide guidance on strategic plan development.

● Responsible for physician education and contract maintenance, network communications, recruitment leads and provider retention.

● Develop and implement innovative approaches to Provider Relations and contract implementation using strategic reimbursement methodologies to include bundled payments, value-based purchasing, optimize payment and reimbursement structures.

● Increase compliance around mandated quality metrics.

● Communicate proactively with direct reports, and internal partners to ensure efficiency of business initiatives

● Develop and maintain strategic relationships with third party payors and external stakeholders.

● Analyze operational and financial feasibility of contract terms.

● Partner with departmental leaders to assess financial and legal compliance

● Develop process improvements to enhance work efficiency.

● Mentor and develop team of 7 in-office and 28 remote Provider Relations Liaisons and Account Leads. Molina Healthcare, Houston TX 2011 - 2019

Contract Manager/Network Development

● Negotiated, executed, redline and analyzed contractual agreements with Individual Physicians, Large Medical Groups, Ancillary, Hospital and Behavioral Health providers

● Negotiate and execute all levels of provider contracts; Pay for Performance, Value Based Contracts, Capitation Agreements and Telemedicine Agreements consistent with organizational goals

● Served as Subject Matter Expert for provider recruitment projects.

● Managed and support cost savings initiatives.

● Working closely with Executive level leadership to develop/implement standardized provider contracts and contracting strategies.

● Participate in internal/external meetings involving provider network activity.

● Policy and procedure development

● Streamline internal and external process

● Rebranding department foundation throughout Texas

● Strategic budget planning to create market savings and target lucrative business partnerships.

● Conduct Hospital/large group presentations to promote and maintain business relationships

● Introduce state initiatives/products to outline impact to providers and health plan.

● Developed/implemented internal program to increase internal communication between departments

● Negotiate/Track provider Letters of Agreement, contracts, and amendments from initial draft to full execution.

● Support state wide network development to including researching, recruiting and contract negotiation.

● Evaluation of provider network and implementation of strategic plans to network adequacy.

● Clearly/professionally communicate contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.

● Manage and coordinate supportive services statewide; managing mail distribution, contract implementation and contract audit.

Nikki Hall

Mir, Fox & Rodriguez, P.C.., Houston, TX 2007 – 2011 Project Manager (Call Center/ Records Management), Healthcare Coordinator

● Establishing multiple Contact Centers to aid families impacted by natural disaster nationally

● Staff development

● Monitor KPI (key performance metrics)

● Analyze call trends

● Coordinate in-bound/out-bound call teams to collect/distribute program guidelines.

● Verify recipient eligibility for program placement

● Report statistics to local and state officials

● Policies and Procedures development

● Database development to track Physician Interest requests

● Facilitate Joint Operation meeting

● Developed cross-functional team initiatives to meet the goals of the organization Great West Healthcare, Houston TX 2006 – 2007

Senior Provider Relations Coordinator

● Contract negotiations/renegotiations for medical providers (Groups, IPAs, Hospitals & Ancillary facilities)

● Facilitate in-service, provider meetings/orientations.

● Initiate provider credentialing.

● Conduct site visits.

● Provider directory development and maintenance

● Maintained provider records internally.

● Provided complaint resolution.

● Claims research and resolution.

● Active liaison for both physicians and managed care company

● Successfully recruited providers and facilities in previously closed networks

● Actively recruited providers and facilities in new territories

● Developed/maintained professional business relationships throughout service area. United Healthcare (Ameri Choice) 2000 – 2006

Quality/Compliance Supervisor

● Responsible for 6 enthusiastic employees: development, coaching/training and compliance

● Conducted weekly calibration meetings with Health plans (New York, New Jersey, North Carolina, and Florida)

● Developed Quality and Compliance manual to establish corporate standards throughout Ameri Choice United Healthcare (Ameri Choice)

Internal Provider Relations & Customer Service

● Benefits coordination

● Provider liaison: recruitment, education, and orientation

● Audit encounter reports, cap reports, and claim reports.

● Claims and complaint resolution

Contact this candidate