Provider relations
Resume:
Anne Marie Brown
**** ******** **. **** ******, FL 34684 Cell: 248-***-****
**********@*****.***
https://www.linkedin.com/in/anne-marie-brown-81761a13/
Education
Master of Business Administration Business Baker College of Graduate Studies
Bachelor of Science University of Michigan
Statement
Self-motivated, goal oriented and purposeful critical thinker ready to be a lead by example in/out of the workplace. By working through collaborations with fellow employees, clients and friends; quantitative success for all will be the ultimate result. Ambitious professional constantly looking to learn, grow and build upon all foundational lessons learned to then apply to an evolving real world.
I build and maintain effective relationships with organized delivery systems, physician medical groups, individual providers and administrative staff. Offer education resources/tools and reports necessary to improve practice clinical and quality outcomes and business performance at all levels of the organization. Implement network engagement strategies to evaluate improve cost, quality and the patient’s experience of care.
Managed teams and worked remotely for several years. During this high stress time, I can be an asset to your team by managing projects and teams remotely. Experienced with Medicaid, Medicare, Commercial, Exchange and DSNP product lines of business. Highly experienced with STARS/HEDIS/MRA/HCC/Care Gap Closure
Professional Experience
Datalink Software
Director Provider Relations
7/20- present
Created strategy for performance improvement for medical groups
Trained Value-based enablement through technology
Created Provider/Staff adoption rates
Created operational & workflow optimization
Hired and managed ten new provider engagement staff members
Created training on HEDIS/STARS/MRA/HCC
Centene, Corporation-Sunshine Health
Manager, Provider Relations
Team manages all statewide projects for provider partnership staff
Telemedicine lead for Medicaid
Lead telemedicine projects to provide telemedicine grants to providers in the Sunshine Health community
Project manage and distribute projects to team
Assisted with daily issues, mentor and coach staff members
Supported department by providing analytics and monthly reports to leadership and staff
Provided training to staff across the state
Lead for Network Optimization Workgroup which analyzes Florida network for provider retention
Participant on Network Transformation Team which analyzes all providers to determine viable of retention
Worked closely with contracting to determine terms of contract during consolidation process
Assisted with roll out of Value Based Purchasing (VBP) to PPM staff member
Trained teams on HEDIS/STARS/MRA/HCC re-validation
Monitored and maintain VBC reports
Led additional staff members during State of Emergency
Trained staff on VBC contracts
Centene, Corporation-Sunshine Health
Provider Relations Manager Lead for Florida
9/17- 3/19
Project manager of statewide projects as assigned by manager, director and VP (ITN, CMS audits, LexisNexis, Provider Communications, NCQA reporting, Network Sculpting)
Project manage telemedicine rollout for the Medicaid line of business
Acted as a resource and point of contact for management and PPM staff members
Coached and train newly hired PPM staff across the state
Assisted with daily issues, mentor and coach staff member
Trained staff STARS/HEDIS/MRA/HCC
Centene Corporation- Sunshine Health
Provider Partnership Manager Pinellas County
3/16- 9/17
Facilitated provider network building by recruiting PCP, SCP and Ancillary providers
Team member for Provider Manual updates
Wrote policy for Provider Manual
Lead member of Pay for Performance Work Group
Assisted managers in hiring of new team members
Conducted initial provider orientations and ongoing educational outreach to the provider community
Educated providers regarding policies and procedures related to referrals, claim submission, credentialing documentation and web site education and CMS guidelines
Engaged providers and educate them on PCMH initiatives, perform HBR/MCR analysis, HEDIS analysis and review provider performance materials
Performed contracting duties including negotiation, value based contracting, delegated agreements and credentialing process
Built and maintained provider networks that promote quality customer outcomes
Developed and implemented activities for recruitment, contracting and retention of effective providers to promote evidence based practices
Meet with contracted providers to develop long term relationships, resolve operational issues, and collaborate regarding effective treatment modalities and outcomes
Evaluated and negotiated contracts with PO/PHO and direct contracts
Maintained state governmental and community relationships
Evaluated the need for additional providers/specialist for identified populations
Analyzed provider performance and profiling for interventions data
Assisted director with corporate policy and procedure
Mentored/coached provider groups for quality care gap closures
Centene Corporation- Michigan Complete Health
Provider Partnership Manager Oakland County
4/15 to 3/16
Contracted new providers to create network for new health plan in Michigan
Facilitated provider network building by recruiting PCP, SCP and Ancillary providers
Conducted initial provider orientations and ongoing educational outreach to the provider community
Educated providers regarding policies and procedures related to referrals, claim submission, credentialing documentation and web site education and CMS guidelines
Engaged providers and educate them on PCMH initiatives, perform HBR/MCR analysis, HEDIS analysis and review provider performance materials
Performed contracting duties including negotiation, value based contracting, delegated agreements and credentialing process
Built and maintained provider networks that promote quality customer outcomes
Developed and implemented activities for recruitment, contracting and retention of effective providers to promote evidence based practices
Meet with contracted providers to develop long term relationships, resolve operational issues, and collaborate regarding effective treatment modalities and outcomes
Evaluated and negotiated contracts with PO/PHO and direct contracts
Maintained state governmental and community relationships
Evaluated the need for additional providers/specialist for identified populations
Analyzed provider performance and profiling for interventions data
Assisted director with corporate policy and procedures
Priority Health
Provider Account Representative for Counties: Washtenaw, Livingston, Monroe, Lenawee and Toledo
5/12 to 4/15
Lead on JOC meetings with PO/PHO for PH Team
Analyzed Total Cost of Care Reports for ACN Groups
Assisted contracting with PFP audits, credentialing issues and designation letters
Evaluated Cost Variation Reports for ACN Groups
Initiated Incentive Programs for ACN Groups with Director approval
Project Manager lead on University of Michigan project
Lead on quarterly meetings with ACN groups
Work Group Analysis for PHO/PO pertaining to :
oClinical Collaboration
oAccess and Experience
oContinuous Improvement
oFair and Transparent Cost
oEconomic Alignment
oHEDIS requirements
Assisted in contracting issues for PHO/PO
Primary Care Physician Incentive Program Administration, Improvements and Education
New practice orientation
Medicaid and Medicare Expansion
PCP terminations and member mass transfers
Prepared and hosted JOC meetings
Assisted with Medicare grievance
Management of special contractual arrangement for groups
Assisted Provider Information Management Team with Demographic updates
Participated in naviHealth rollout to providers
Proficient in Facets, Business Objects, RPX, and Cactus
Assisted with risk contracting for providers
Priority Health
Provider Account Coordinator
5/11-5/12
Educated providers on policy and procedure
Identified and analyzed claims payment issues in a timely manner
Identified contractual issues and assisted with resolution
Identified root cause analysis related to claims issues (volume base, thematic trends)
Promoted use of provider online tools to increase operational efficiency while reducing costs
Handled Provider Appeals (Level 1 and Level 2) for assigned hospital groups, ancillaries and providers
Improved provider satisfaction by completing Inquiries and Appeals in a suitable manner
Identified operational improvement opportunities by improving workflow in claims area
Proficient in Facets, Onbase, Business Objects, Outlook and
Cactus
Assisted Provider Information Management Team with demographic updates
Coordinated and developed material used for provider orientation and billing groups
Assisted providers with contracting issues
Assisted Medicare 5 Star Team achieve goals for 2012
Blue Cross Blue Shield of Michigan
Customer Service Representative II Provider Information Management Center
7/07 to 5/11
Respond to benefit and claim inquires for multiple product lines (Traditional, PPO BPP, EPO etc) while meeting production and quality measures in a high volume call center
Proficient in IRIS, NCSW, MOS, IMSC (3270), NASCO, Bluecard, ITS Host, Content Manager, McKesson, Blue Squared, EOS, Impact 360/Verint and various intranet resources such as Web-Denis, Benefit Explainer, SharePoint, MISource, BluesLink, National Health Care Reform
Ability to research and analyze certificates and riders as well as benefit/medical policy
Utilizes verbal, written and analytical skills to resolve inquiries accurately and in a timely manner leading to stakeholder satisfaction and customer retention
Achieved employee of the month and top tier status since 12/07 by maintaining outstanding quality status
Researched and reviewed provider claims issues and grievances
Call center experience
Dental Hygienist Private Practice
Dr Adam Parsons 1/05-7/07
Birmingham, MI
Senior Hygienist
New ideas and concepts initiated in first quarter of employment
Periodontal Program Initiated
Additional team members added
New products and services offered in office which increased sales
Dr Patrick Ainslie 1/04-1/05
Bloomfield Hills, MI (contact Linda Reed)
Dental Hygienist
Mobile Dentist 1/00-12/03
Farmington Hills, MI
Dental Hygienist and Trainer
Trained staff members in the field as this is a mobile dental unit
Blue Cross Blue Shield of Michigan
Senior Trainer Dental Department 1/88-12/90
Assessed training needs for union employees
Conducted training programs for union employees as needed
Designed Technical Training Manuals for Dental Claims Processing Employees
Determined training policies and procedures as needed for department
Call center experience
Blue Cross Blue Shield of Michigan
Dental Utilization Review Specialist 1/87-1/88
Reviewed claims and dental x-rays for certification of coverage in the cost containment area
Analyzed x-rays to determine if covered under benefit terms
Managed calls from internal dental call center when difficult questions could not be addressed
Call center experience
References
Upon request
Contact this candidate