Managed Care Provider Relations
Resume:
PAULA R. DILLON
Lombard, IL ***** 708-***-**** ***********@*********.***
Summary
A healthcare administrative professional with expertise in healthcare contracting, provider relations, operations, and account management. Negotiates contracts with healthcare providers, maintaining positive relationships with them, overseeing operational processes to optimize efficiency, and managing accounts to ensure financial stability.
Key Qualifications and Skills
Contract Negotiation
Provider Relations
Business Development
Project Management
Strategy Development
Revenue Cycle
Operations
Account Management
Customer Relations
Work Experience
University of Illinois at Chicago 3/2025 – current
Assistant Director of Hospital/Physician Contracts
Provide analytic support for contracting and provider network initiatives in assigned markets. Serve as an internal liaison between the College of Medicine, the University of Illinois Hospital and external managed care stakeholders. Accountable for providing financial analysis of provider payment terms and evaluates financial analysis of contract terms and profitability.
Objectives
Assist Director in managing all divisions within managed care, including contract process and portfolio, development and maintenance of service operations and internal procedures
Assist Director of managing day-to-day operations of the managed care commercial division
Assist Director in managing quality initiatives, including management of network spending
Conduct annual financial reviews of contracted payers to ensure adherence to contractual terms
Cook County Health 6/2024 – 3/2025
Manager, Value-Based Contracts
Provide support for organizational value-based arrangements aimed at improving quality, enhancing experience, promoting equity, and reducing costs for patients and members served by Cook County Health (CCH). Oversight for negotiations and leadership of operations and administration of Cook Medial Group (CMG) delegated risk arrangements.
Objectives
Responsible for negotiation and administration of delegated risk arrangements on behalf of Cook Medical Group (CMG) locations throughout Cook County
Lead day-to-day operations in administering CMG’s partial-risk agreement with BCBSIL
Develop and implement workflows, trainings and policies/procedures
CINQCare 4/2024
Provider Network Consultant
Responsible for all aspects of provider network development for the organization, a designated patient centered health home specifically focused on primary care services for the Medicaid population.
Achievements
Initiated network development activities in select Illinois marketplaces
Monitored all aspects of provider network development/participation in select Illinois markets
Relief Mental Health 9/2023 – 10/2023
Director of Managed Care
Responsible for negotiation of managed care contracts and credentialling of providers.
Achievements
Facilitated timely credentialling of providers
Led contracting and operational initiatives for over seventy-five value-based and fee-for-service agreements, including shared risk and ACO relationships with market payors.
North Kansas City Hospital 11/2022- 1/2023
Director of Managed Care
Responsible for all aspects of managed care contracts, including modeling, language negotiations, and implementation management.
Achievements
Led contracting and operational initiatives for over seventy-five value-based and fee-for-service agreements, including shared risk and ACO relationships with market payors.
Monitored compliance with contract terms and implementation of payor performance scorecards.
Collaborated with market healthcare leaders in oversight of CENTRUS ACO model
Franciscan Ministries 01/2021- 11/2022
Director of Managed Care
Responsible for strategic oversight of the ministry’s participation in managed care networks to drive market growth.
Achievements
Implemented contracting strategies increasing Franciscan’s in-network participation by 35%
Collaborated with partners to increase alignment of organizational strategy and contracting.
Northwest Community Healthcare 10/2018-11/2019
Vice President of Managed Care and Revenue Cycle Operations
Directed activities for 100+ managed care contracts/plans, including Accountable Care Organization, hospital, physician, PHO, and joint venture contracts representing $500 million in annual net revenue.
Achievements
Collaboration with healthcare partners to align organizational strategy and contracting
Facilitate all standing engagements with payor partners to further advance relationship goals
Achieved success in various revenue cycle metrics:
oPatient Access calls – reduced response time from 45 seconds to 25 seconds.
oCash collections – exceeded goals by 11%.
oClaims issue resolution – reduced resolution timeframe from 68 days to 24 days
Illinois Health and Hospital Association 9/2014-9/2018
Director of Managed Care
Led development and oversight of policy and advocacy work focused on commercial insurance, Medicaid, and Workers Compensation.
Achievements
Led activities resulting in the adoption of SB3080 – Managed Medicaid oversight; wrote legislative position papers for IHA members.
Directed implementation of Medicaid MCO “Universal Provider Roster” – resulted in a 15% reduction in credentialing errors and a 20% improvement in credentialling turnaround times.
Implemented quarterly Medicaid MCO Administrative Performance Survey for pilot group of eighty-one member hospitals, achieving participant response rates of more than 80% in four consecutive quarters.
Rockford Health System 2/2008-9/2014
Director of Managed Care
Directed managed care contracting, operational and performance reporting activities. Accountable for management and oversight of over one hundred agreements and representing gross annual revenue of $350 million.
Achievements
Implemented organizational contracting strategies to include financial analysis, language review, and recommendations of alternative payment models
Directed RHS’ role in the 2014 Illinois IPDH Accountable Care Entity initiative – Illinois Partnership for Health – resulting in standard clinical metrics and improving patient access to care.
Led monthly RHS Managed Care Steering committee in monitoring payment timeliness, coding accuracy, accurate clinical documentation, and compliance with MCO administrative requirements.
Education
Master of Business Administration/Organization Development, Benedictine University, Lisle, IL
Bachelor of Arts in Sociology, Grinnell College, Grinnell, IA
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