Provider Relations Behavioral Health

Michelle Neverson Crawford

+1-917-***-**** **********@***.*** East Stroudsburg, PA 18302

linkedin.com/in/michelle-neverson-crawford

Director, Provider Relations

Senior Level Provider Relations Executive with deep expertise within the healthcare industry. Known for leveraging data to influence key decisions, cross-functional collaboration, developing talent and leading teams. Passionate about leveraging skills to deliver organizational success.

Healthcare Insurance Long-Term Care Behavioral Health Providers Team Leadership

Client Relations Cross-Functional Collaboration Microsoft Office Access FACETS MRT

Professional Experience

Centene DBA Fidelis Care, Rego Park, NY

Director, Provider Relations 8/2007 – 10/2023

Managed the Provider Services Team and Long-Term Care and Behavior Health Providers, hospitals, Ancillary Providers.

Implemented and monitored strategic initiatives to develop efficiencies such as developing a directory review which reduced the time spent by 75%, developed a process to reduce work effort for claim review to quickly get to an end result of financial impact, developed a workflow between Provider Relations and Contract Management to communicate to reduce response time.

Worked with staff to implement metrics for provider visits and response time to enhance provider satisfaction. Took the lead when issues were escalated and interacted with senior leadership as necessary.

Managed quality team to successfully meet QARR/HEDIS goals and worked with Value Based team to determine quality incentives.

Collaborated with Vice President of Provider Relations to develop and maintain departmental policies and procedures and Provider Manual.

Recommended and drafted communications relative to Health Plan policies and procedures.

Reviewed contracts for reimbursement accuracy.

Completed all Provider Relations activities necessary to prepare for the annual State audit.

Interfaced with other departments to ensure accurate and appropriate configuration of contracts, database maintenance, claims, provider recoveries, reimbursement rates, benefits configuration.

Reviewed provider contracts to ensure Provider Fee Schedule accuracy.

Worked to resolve escalated claim issues.

Developed and implemented action plans regarding provider satisfaction results.

Additional Relevant Experience

Out-of-Network Negotiations Contracting Manager, MagnaCare, Garden City, NY

Negotiated contracts with a 98% success rate of the benchmark parameters which produced savings.

Senior Manager of Contracting, Network Management, 1199 National Benefit Fund, New York, NY

Oversaw all contracting with providers and implemented incentives for the staff to meet goals.

Professional Recruitment Specialist, Horizon Healthcare of New York, New York, NY

Developed network for the New York region by recruiting and contracting with providers

Manager, Provider Services, Healthfirst, Inc., New York, NY

Responsible for management of network provider for the New York City region.

Education

Master of Public Administration, (MPA), Health Administration, Long Island University, Brooklyn, NY

Bachelor of Science (BS), Finance, College of Staten Island, Staten Island, NY

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