Business Development Health Plan
Resume:
Alexander Davila
Healthcare Professional Provider Contracting Business Development.
Contact Number: 305-***-**** ****************@*****.***
Delray Beach Fl 33445-
The Physician Relations Representative is responsible for fostering a strong and satisfied network of healthcare providers in a designated area. Serve as the main liaison between practices, the company, and health plan partners. The main focus is to work closely with providers to improve performance in areas like cost reduction, revenue optimization, quality enhancement, and provider satisfaction.
MED-PRO Medical Group Inc. – Sr. Provider Contracting Business Development.
Consulting Contract Negotiations Rate Increases Business Analytics.
From: 12-01-2022 To Present.
Key Responsibilities:
Provider Education and Support: Provide comprehensive education and tools to help providers meet quality and financial goals.
Accountability and Performance: Understand and improve the financial performance of practices, ensuring they meet key performance indicators.
Provider Training and Orientation: Conduct orientation sessions and ongoing training for providers and their staff.
Provider Retention: Work to retain providers by ensuring their satisfaction with the organization.
Provider Collaboration: Facilitate meetings to enhance patient outcomes and operational efficiencies.
Performance Improvement Plans: Develop, implement, and monitor improvement plans for provider groups.
Provider Negotiations: Negotiate contract terms and analyze proposals.
Communication and Issue Resolution: Maintain open communication channels and resolve issues promptly.
Strategic Planning: Collaborate to implement strategic interventions.
Onsite Provider Visits: Spend most of the workweek visiting providers, with clear objectives for each visit.
Engagement with Specialists: Focus on engaging high-quality specialists and improving coordination of care.
HUMANA Inc. From 08-01-2007 to 12-01-2022
HUMANA Inc. Sr. Contracting Professional I Business Development.
Negotiates, executes reviews analyzes contracts, and handles dispute resolutions and
Settlement negotiations with ancillary providers for all Lines of Business (Medicare, Commercial and IFP)
Recruit providers as needed to ensure the attainment of network expansion and adequacy targets for all Lines of Business.
Provides network development maintenance and refinement activities and strategies in support of cross-market network management unit.
Provider Education improvement plans and account management.
HUMANA Inc. Sr. Medicare Risk Adjustment Medical Risk adjustment
Build lasting relationships with Humana’s customers
Change primary care physicians and use all the systems.
Apply the contract in all interactions with our members.
Hedis 2015 Project Measure Guidelines and checklist.
Analyzed data to guarantee key performance measures are met.
Prior experience with CCP2, CI.HOD. Verisk Health.
Receive, document, and resolve customer inquiries by using established best practices.
Education:
2005 Miami Dade College- MBA in business management
2005 Completion in Management Skills in Health Care and Administration.
2015 HealthCare and Administration and data analysis Humana.
1998 American High School, Miami lakes Fl.
Accomplishments
#1 Award for the best MRA scores 2015.2016.2017.2018
#1Humana Star Award in Recognition for the HEDIS Project 2018.2019
Award from the American Diabetes Association for Step Out Walk Fundraising.
#1 For Medicare Risk Adjustment RADV. Medicare, Medicaid and Commercial.
Team Leader of the Year 2018.2019.2020.
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