Professional Positions and Field Experience:

Provider Contracting and Payer Relations

Norman H. Anderson, MD PA dba Robert Boissoneault Oncology Institute

Development of new and existing relations with payers and community providers.

Managed care contracting, payers policies, physician reimbursement methodologies and state regulatory requirements.

Lead and motivate the RBOI team towards the accomplishments of work and organizational goals.

Evaluate, negotiate and secure financially and administravely favorable managed care contract with new and existing health plans and managed care organizations.

Monitor of plan renewals, budget increases and ensure that all renewals are completed timely.

Work with CFO for budget increases annually.

I am the resource for information about contract terms, managed care projects, payer processes, revenue cycle inquiries and facilitate the resolution of complex issues that arise.

Seek opportunities for new patient volumes through payer initiatives.

Manager Contracting and Network Development,

Ultimate Health Plans

Manager Provider Relations,

WellCare Health Plans

Provider Contracting with Providers, Facilities, MSO, PHO and ACO

Network building in expansion service area.

Monitor current services area specialty gaps. Recruit specialty to avoid service interruption for our members.

Review Single Case agreements (SCA) or Letters of Agreement (LOA) to assure it meets our policy standards and rates requirements. Convert these SCA/LOA into direct contracts. This helps close some of the specialty gaps identified in our service area.

Managed an amazing team. Enjoyed providing guidance, hands on experience and tools for their everyday work needs.

Senior Provider Relations Representative –

WellCare/Ultimate/Aetna/Prudential

Senior Network Development Representative –

WellCare/Ultimate/Aetna/Prudential

Senior Managed Care Specialist –

Seven Rivers Regional Medical Center

Monthly provider communications, with company updates, contract terms, payment and reimbursement changes.

Review HEDIS/MLR measures and gaps with Providers and Staff

Provider training and educational meeting with service area providers and staff.

Most importantly keep strong business relations with these offices.

Financial Counselor/ Secretary/Office Supervisor –

Hialeah Hospital/MSMC

Collect balance due on ER patient. Discuss payment plans and insurance options.

Coordinate medical care for our Eldercare patients. Transportation to schedule appointments.

Order any and all DME equipment and supplies needed for our Eldercare patients.

Maintain Physician CME credit courses, schedules and travel arrangements.

Work History

Norman H. Anderson, MD PA dba Robert Boissoneault Oncology Institute

2020 SE 17th Street

Ocala, Florida 34471

Ph: 352-***-****

March 2020 to Present

Ultimate Health Plans, Inc.

1244 Mariners Blvd.

Spring Hill, Florida 34609

Ph: (855) ULT-PLAN

July 2016 to March 2020

WellCare Health Plans

8735 Henderson road

Tampa, Florida 33634

Ph: 813-***-****

April 2012 to April 2016

*May-June2016 assisted my parents in Miami with my Dad’s stroke and nursing home placement.

Universal Health Care Group

100 Central Avenue, Suite 200

St. Petersburg, Florida 33071

Ph: 866-***-****

October 2008 to April 2012

Seven Rivers Regional Medical Center

6201 N. Suncoast Blvd.

Crystal River, Florida 34428

Ph: 352-***-****

October 2006 to October 2008

*January 2003 to October 2006 we relocated to Citrus County. Real Estate Agent for ERA Realty.

Aetna US Healthcare Inc. / Prudential Healthcare Inc.

8201 Peters Road – Suite 201

Plantation, Florida 33324

Ph: 860-***-****

May 1998- to January 2003

Education:

2015 College courses at St. Petersburg College.

Coaching for Peak Performance.

2014 College course at Development Dimensions International

Essentials of Leadership

1981 College course at Miami Dade Community College

Business Administration and Finance

1980 Graduated from High School with Diploma

High School Diploma

References:

Dr. Robert Sutton, Medical Director Ultimate Ph: 407-***-****

Marco Martinez, VP LabCorp Ph: 954-***-****

Rande Thompson, VP Quest Ph: 407-***-****

James Puckett, Sr. Manager WellCare/Humana Ph: 813-***-****

Eric Sternberg, COO and Founder One Source-DME Ph: 813-***-****

Contact this candidate