Lisa Robinson

Professional Profile:

**+ years of negotiating and contracting experience

** ***** ** ******* ********** in a managed care setting

Establishes relationships with medical and dental providers; (i.e., RHCs/Rural Acute care Hospitals;, Professional Physicians’ groups, Ancillary, ASC, Imaging/Radiology groups, PCM/PCP OB/GYN Womens’ Health, Urgent Care, SNF/LTAC, BH providers and delegated providers, DME companies) to expand MCO network

Negotiates, re-negotiates, executes contracts, and sets fee schedules; and educate providers

Making executive decisions for the best interest of the patients in need, the providers we service, management of direct staff and the company and its subsidiaries Work Experience:

October 2019-Present TriWest HealthCare Alliance Phoenix, AZ Manager, Direct Contract Manager (Current Position)

• Negotiated, renegotiate and executed Facility and provider contracts in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals

• Work with Provider Services leadership to access the providers needs within the assigned region and establish strategies to achieve a successful outcome

• Proactively help manage the provider networks in the assigned areas as the primary spokesperson on the network issues

• Provides regular updates to the Senior Manager and/or VP regarding provider network development, management, and access for assigned areas.

• Ensured compliance with Federal and state regulations and VA requirements with Medicare, Medicaid, Federal insurance programs, approved VA Pharmacy Formulary programs

• Provided assistance with training on daily processes including excel worksheets and other applications to other team members

• Communicate information regarding market needs, competition, and industry trends to management team

• Maintain Client confidence and ensure confidential information is protected and follow the HIPPA Laws and Company Policies & Procedures

• Maintain current and updated knowledge of all programs, credentialing, contracting, reimbursement and operational policies and TriWest initiatives, operations, and goals

• Collaborate closely with other teams and department leadership, staff and

• executive leadership on process improvement to help promote service level improvements and assist with new processes

• Provided service and support to maintain a strong relationship with TW internal and external Providers and customers

• Claims review, authorization review, research provider records to determine if a Direct or Net Sub contract, education

POC: Lisa Robinson Email: adr3ui@r.postjobfree.com PH: 602-***-**** May 2019- October 2019 HCS HealthCare Support Staffing Maitland, FL Direct Contracting Manager-TriWest HealthCare Alliance, Phoenix AZ (Successfully Completed Contract}

• Negotiated, renegotiate and executed Facility and provider contracts in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals

• Work with Provider Services leadership to access the providers needs within the assigned region and establish strategies to achieve a successful outcome

• Proactively help manage the provider networks in the assigned areas as the primary Spokesperson on the network issues

• Provides regular updates to the Senior Manager and/or VP regarding provider network development, management, and access for assigned areas.

• Ensured compliance with Federal and state regulations and VA requirements with Medicare, Medicaid, Federal insurance programs, approved VA Pharmacy Formulary programs

• Provided assistance with training on daily processes including excel worksheets and other applications to other team members

• Communicate information regarding market needs, competition, and industry trends to management team

• Maintain Client confidence and ensure confidential information is protected and follow the HIPPA Laws and Company Policies & Procedures

• Maintain current and updated knowledge of all programs, credentialing, contracting, reimbursement and operational policies and TriWest initiatives, operations, and goals

• Collaborate closely with other teams and department leadership, staff and Executive leadership on process improvement to help promote service level improvements and assist with new processes

• Provided service and support to maintain a strong relationship with TW internal and external Providers and customers

February 2018-August 2018 Cognizant Technologies Phoenix, AZ Configuration Analyst / Analyst III (Successfully Completed Contract)

• Handled all edits, testing, and operations of FACETS programming and SQL database

• Created and utilized txt files in test & production environments

• Created, tested, and implemented data from testing to production through CFO, TEST-DEV, UAT, CF2 & PROD for beginning production environments for claims December 2011-September 2016 Coventry/Aetna Health Care Scottsdale, AZ Provider Network Specialist, Supervisor (Company Layoffs)

• Negotiated, re-negotiate and executed physician and/or provider contracts in accordance with Company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals

• Ensured accountability for financial summaries

• Ensured compliance with Federal and state regulations and carrier requirements with Medicare, Medicaid, Federal insurance programs, Pharmaceutical PBM programs

• Prepared budgets and analyze financial reports

• Oversaw all carrier Partner audits and maintain business relationships POC: Lisa Robinson Email: adr3ui@r.postjobfree.com PH: 602-***-****

• Coordinated with carriers all fulfillment and all other necessary information requiring updates and/or development to comply with state and carrier requirements

• Collaborated with multiple functional health plan departments to build out a strategic payment innovation roadmap

• Developed and implement provider network innovation, optimization standards and guidelines to increase market share, revenue growth, and quality outcomes

• Lead a cross-functional team and work across the health plan to implement targeted value based contracting initiatives (Pay for Performance, Shared Risk and Reward, Accountable Care Partnerships)

• Managed, plan and prioritize workload for a staff of 16 employees to meet organizational deadlines

• Oversaw strategic planning of existing contracts and re-negotiating provider contracts and obtaining credentialing applications and supporting credentialing documents required by URAC to participate in network

• Collaborated with multiple functional health plan departments to build out a strategic payment innovation roadmap. Using the newly developed roadmap, lead implementation of prioritized initiatives in partnership with Provider Network Management, Medical Management, Product, Claims, Sales and Marketing, Finance and Actuarial teams

• Contracted negotiation skills to contract provider types: Behavioral Health RBHA, SNF, Home Community Based Services, Ancillary/DME, Hospital, Physicians and Dentist. Understanding of contract management, compliance, and credentialing

• Knowledge of all AZ Medicaid (AHCCCS) programs

• Communicated with all levels of management: C-Suites, VP level and Director/ Manager levels June 2009-December 2011 J.P. Morgan Chase Phoenix, AZ Auto Collection Supervisor (Found Contracting Opportunity)

• Supervised, trained, evaluated and monitored on-the-job performance of staff responsible for collections

• Ensured all collectors follow federal collection laws

• Analyzed, reported and maintained daily, weekly and monthly production on collectors

• Document and keep senior management up to date

• Responsible for Bucket II which comprised of 12 direct employees and 10 indirect teams for repossessions, payments, and customer service inbound/outbound calls and collection duties who managed overdue auto accounts on 30 up to 90 day past due queues for final resolution

• Identified deficiencies, handled reviews and monitors call performance, assurance and provides feedback as well as coaching to staff as necessary

• Identified opportunities for success and growth within organizations operations November 2005-February 2009 SCF Arizona Phoenix, AZ Provider Contracting Specialist, Team Lead (Company Lay Offs)

• Accountable for the expenditure of $170 million in annual medical claims cost as well as successfully achieving 100 million annual Cost Containment representing approximately 58% of overall claims medical savings

• Managed various extended business service partners located throughout various part of the United States who assisted SCF Arizona in managing medical claims costs

• Developed and implemented the first Nurse Case Management contracting program, as well as the first Investigation (SIU) contract agreement and program, cost-containment strategies, programs and initiatives-both existing and proposed.

• Coordinated with 3 Medical Directors for medical and credentialing reviews and recertification

• Managed all aspects of SCF Arizona wholly owned PPO - Preferred Connection Network (PCN), and including members solicitation, credentialing, rate negotiations, contracting and advertisement

• Responsible for the development, implementation and measurement of SCF Arizona claims medical management and medical Cost Containment policies and strategies POC: Lisa Robinson Email: adr3ui@r.postjobfree.com PH: 602-***-****

• Managed key relationships with the medical community and direct all activities of SCF Arizona consultative Medical, Chiropractic, Dental, Hospitals, and other provider advisors

• Coordinated administration of existing Cost Containment programs and initiatives, as well as investigation, analysis, evaluation, development, implementation of new medical Cost Containment programs

• Researched, negotiated, and implemented new cost savings programs generating average cost savings of

$20 million dollars annually

• Directly managed the performance and development of a group of Workers Compensation professionals comprised of Utilization Review of Nurses, Field Case Nurse Managers, Medical Billing Supervisor, and Supervisor of Medical Networks, Claims and Provider Relations

• Ensured compliance with Federal and state regulations and carrier requirements

• Oversaw new provider innovation projects and program initiatives, including staff allocation, deliverables, milestones, and goals

• Collaborated with Network Development team on payment innovation work and become the Arizona health plan voice on various corporate committees and initiatives related to payment innovation strategy

• Oversaw the Assists of users in testing, training, and preparation for operations

• Researched, developed and implemented provider network innovation and optimization standards and guidelines to increase market share, revenue growth, and quality outcomes

• Responsible for coordination across teams (such as DMG and configuration) and across subsystems (Ref, claims, prov and elig). Medicaid and SQL Server. Coding for production and writing queries for data analysis to assist with design and testing verification June 2003-November 2005 CorVel Corporation Phoenix, AZ Provider Relations Manager (Company Lay Offs)

• Established and maintained processes and systems in place to provide routine services to various extended business service partners including contract management and credentialing providers located throughout various part of the United States

• National database Approved for various extended business service partners located throughout various part of the United States who assisted CorVel Corporation in managing medical claims costs

• Responsible for uploading Arizona Foundation for Medical Care PPO providers and network value-based payment system for 48 states into Database systems

• Handled quarterly collections cleanup on existing and new data provided by Arizona Foundation for Medical Care

• Oversaw all provider contracting, negotiated contracts and credentialing of 3800 Providers in Arizona

• Responsible for NDB collections cleanup with other provider adds, edits and updates.

• Directly assisted the Nurse Case Managers and staff with existing cases with negotiating tools and tactics to assist the providers with new caseloads and collections of accounts.

• Managed MedCheck provider relations department of 5 and bill review for Auto, and Group Health of 15.

• Coached and delivered the understanding of contact delivery paths and how call volumes, call types and call complexities impact the staffing plan

• Monitored service levels to meet department goals. Monitored customer feedback to meet call center metrics including abandonment rates, average speed of answer, after call work flows and quality

• Oversaw market and solicit all of CorCare Ancillary products and services including member’s solicitation, credentialing, rate negotiations, contracting and advertisement Education:

POC: Lisa Robinson Email: adr3ui@r.postjobfree.com PH: 602-***-****

University of Ottawa – Master’s in Utilization Review and Network Development

University of Phoenix – Master’s in Business Administration; Minor in Accounting and Pre-Law

St. Ambrose University – Bachelor’s in Business Administration and Medical Management Professional References:

Available upon verbal request and/or written communication POC: Lisa Robinson Email: adr3ui@r.postjobfree.com PH: 602-***-****

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