Clemencia Acosta

https://www.linkedin.com/in/jjepns

Miami, Florida 33131

ad3vhn@r.postjobfree.com 305-***-****

Healthcare Administration Expert

Professional with 26 years’ success in contract value management for large high-growth organizations.

Passionate healthcare professional with over 26 years’ experience in contract value management. Astute businessperson; able to forge solid relationships with strategic partners and build consensus across multiple organizational levels. Bilingual speaker, writer and communicator in English and Spanish.

Selected Accomplishments:

Instrumental in Start-Up of a Dental Health Management Organization that exited at $450M.

Created a network of over 3,000 general dentists and specialists throughout the entire State of Florida.

Successfully developed and trained a group of 15 inside and outside provider relation specialists.

Chairman of the Claims and Credentialing Committees resulting in a reduction of expenses of 20%.

Consistently managed the credentialing of over 3,000 providers.

Recruited and Contracted almost 100 Individual Private Practice Physicians, MSO.

Controlled surpluses, deficits, and bonuses of the IPA’s.

Highlights of Expertise

Contract Value Management

Provider Relations

Internal Staff Recruitment & Training

Provider Network Development

Regulatory Compliance and Accreditation

Business Development

Compliance and Grievance Resolution

Practitioner & Staff Orientation and Training

Negotiation Skills

Computer Skills

Career Experience

Independent Healthcare Consultant, Miami, Florida

OWNER/OPERATOR (05/2020 to Present)

Consultant for Start-Ups, Multi-Functional Facilities, C-Suite Executives, Mid-Size to Large Healthcare Companies, and Investors.

Improved processes to maximize profits, created strategies to make outcomes successful, analyzed data to make suggestions to develop better products.

Corporation / Humana / Conviva Healthcare Solutions, Miami, Florida

DIRECTOR OF PROVIDER RELATIONS / MANAGER (05/2010 to 04/2020)

Managed a regional provider relations team, ensured day to day work is performed effectively and aligned with larger strategic companywide objectives across the region including financial targets. Lead PR Team to ensure satisfaction of providers as well as internal customers, clients, and regional leaders. Confirmed compliance with internal, client, regulatory, and accreditation standards as well as successful audit processes. Collaborated with network strategy leadership to execute on process improvement initiatives related to provider satisfaction impacts and root cause of issues to achieve shorter provider inquiry response times. Increased provider satisfaction. Developed strong provider relationships, built on trust and collaboration. Oversaw coordination of practitioner and staff orientation and training. Collaborated with Quality, MRA, HEDIS coding teams. Contributed to provider communication materials including but not limited to: Newsletters, Provider Manual, Mailings, Termination Letters, and Training Resources.

Exclusive Provider Network Services, Inc., Miami, Florida

PRESIDENT/OWNER (04/2005 to 05/2010)

Created this company to provide network development, enhanced benefit packages and selection of providers for employer groups as well as HMO's. Allowing for "boutique" access to dentist and vision providers. By creating specialized networks, the group was catered to their specific needs, avoided hassles with group identification and allows provider staff to better identify their needs. Personally, contracted and selected the providers and trained them and their staff on the services and how to manage the plan.

Atlantic Dental, Inc./HSC Health and Wellness, Coral Gables, Florida

VP PROVIDER RELATIONS/OPERATIONS, BUSINESS DEVELOPMENT (03/1997 to 03/2005)

Managed a statewide provider relations team, ensured day to day work is performed effectively and aligned with larger strategic companywide objectives across the state including financial targets. Lead PR Team to ensure satisfaction of providers as well as internal customers, clients, and regional leaders. Confirmed compliance with internal, client, regulatory, and accreditation standards as well as successful audit processes. Collaborated with network strategy leadership to execute on process improvement initiatives related to provider satisfaction impacts and root cause of issues to achieve shorter provider inquiry response times. Increased provider satisfaction. Developed strong provider relationships, built on trust and collaboration. Oversaw coordination of practitioner and staff orientation and training. Contributed to provider communication materials including but not limited to: Newsletters, Provider Manual, Mailings, Termination Letters, and Training Resources. Created the Tooth Fairy Club which promoted dental health for children.

ADDITIONAL EXPERIENCE

VP of Marketing (05/1985 to 03/1997) Transcontinental Developers Corporation, Miami, Florida

Assistant Buyer / Manager / Special Events Coordinator (12/1979 to 03/1985) Burdines, Miami, Florida

Education & Credentials

Florida International University, Miami, Florida

BACHELOR OF SCIENCE IN MASS COMMUNICATIONS AND JOURNALISM

Technical Proficiencies: MS-Suite (Outlook, Excel, Word), Availaty, Carebook, Datalink

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