Data Analyst Csr
Resume:
BRONX, NEW YORK *****
*********@*******.***
MARLENE SALISBURY
OBJECTIVE Seasoned healthcare professional with over 15+ years of exceptional organizational, administrative, and customer relations skills-Pursue a position where my developed skills, a keen eye for operational details, and ability to work independently can support and improve organizational goals and objectives.
SKILLS & ABILITIES Contract Language • Negotiations • Problem-solving • Process Improvement • Training & Development Verbal & Written • Clinical Data Analyst • Strategic Planning • Microsoft Office
• Project Management Interpersonal & Communications• Time Management • Policies & Procedures • Contract management software • Trained on FACETS and MEDNET operating systems.
EXPERIENCE Contract Manager, Network Management, Optum Health Services - LA CROSSE, WI
October 2021 to Present
• Recruit and manage the development of the Veteran's Affairs Community Care Network (VA CCN). Research provider footprint and evaluate for gap filling
• Manage performance target setting, performance reporting and associated financial models relative to provider network contracting.
• Manage unit cost budgets, target setting, performance reporting and associated financial models.
• Guide development of geographically competitive, broad access, stable networks that achieve objectives.
• Evaluate, understand, and negotiate provider contracts in compliance with company templates, reimbursement structure standards and other key process controls. Contracting Associate, AFFINITY HEALTH PLAN – BRONX, NEW YORK June 2018 – September 2021
• Recruit and manage Ancillary providers and address provider issues related to contract timing, set up, and payment disputes.
• Responsible for negotiating with facilities joining the health network and setting rates.
• Process and carefully manage contracts amendments through various contract database system.
• Assist with Single Case Agreements with Out Network negotiators, approving emergency service, and adjudicating special projects. Coordinate with the department's credentialing, ensure official contracts are implemented efficiently, accurately, and on time. Page 2
UNITED HEALTH GROUP—KINGSTON, NY
Sr. Physician Advocate June 2002 to April 2017
• Developed and managed healthcare contracts standards to achieve company objectives, including implementing network strategy and negotiating rates for physicians.
• Assigned physician network territory, filling physician gaps with geographic-specific competitive rates and cost targets.
• Monitored processes related to contract loading, performance issues, and provider appeals, and services.
• Recruit and manage Ancillary providers and address provider issues related to contract timing, set up, and payment disputes.
• Responsible for negotiating with facilities joining the health network and setting rates.
• Process and carefully manage contracts amendments through various contract database system.
• Assist with Single Case Agreements with Out Network negotiators, approving emergency service, and adjudicating special projects. Coordinate with the department's credentialing, ensure official contracts are implemented efficiently, accurately, and on time. EDUCATION Mercy College—Dobbs Ferry, NY
BA in BUSINESS ADMINISTRATION August 1993 to May 1995 SUNY Farmingdale—Farmingdale, NY
AS in BUSINESS ADMINISTRATION August 1989 to May 1992 REFERENCES AVAILABLE UPON REQUEST
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