Revenue Cycle Provider Credentialing

Professional Summary: Results-driven healthcare financial operations and contracting leader with extensive experience in credentialing, payer contracting, revenue cycle optimization, and vendor negotiations. Proven ability to streamline payer enrollment, manage provider credentialing, and secure favorable contracts while ensuring regulatory compliance. Adept at managing multi-state credentialing processes, negotiating payer agreements, and mentoring teams to enhance operational efficiency. Expertise in commercial and government payer enrollment, contract compliance, and provider network management.

Key Skills and Competencies:

Provider Credentialing & Enrollment CAQH, NPPES, PECOS, Medicaid/Medicare Enrollment

Payer Contracting & Negotiations Revenue Cycle Optimization

Multi-State Contracting & Network Participation Vendor & Payer Relationship Management

Contract Negotiation & SLA Compliance Project Management & Process Improvement

Compliance & Regulatory Oversight

Professional Experience:

Fortrea Patient Access (RX Management) (Neovance)

Vendor/Procurement Manager (Workforce Reduction)

July 2024 – December 2024 Durham, NC

Managed payer and vendor contracts, ensuring compliance with indemnification and liability terms to protect revenue.

Negotiated provider and payer agreements, optimizing reimbursement structures, and reducing administrative burdens.

Led credentialing and provider enrollment processes, streamlining documentation, and improving payer communications.

Developed contract review policies that ensured provider credentialing and payer participation compliance.

Convey Health Solutions

Sr. Client Services Category Manager (Relocation)

March 2022 – August 2023 Miramar, FL

Managed vendor relationships, ensuring strategic alignment with banking and financial risk management standards.

Oversaw vendor contract compliance, SLA adherence, and financial reporting.

Facilitated resolution of key vendor issues, balancing internal resources for project execution.

Increased client satisfaction by 30% through optimized service delivery.

Developed and executed strategic sourcing initiatives, ensuring cost-effective and high-quality vendor partnerships.

Negotiated vendor contracts and agreements, optimizing pricing, service levels, and compliance.

Managed end-to-end procurement operations, including RFP development, supplier selection, and performance monitoring.

Experienced conducting MBRs/QBRs/Annual reviews to VP and C-level executives, demonstrating value and ROI.

Managed payer and vendor contracts, ensuring compliance with indemnification and liability terms to protect revenue.

Reviewed billing contracts, incorporating force majeure clauses to safeguard financial stability.

Highmark Corporate Headquarters

Vendor Category Procurement Manager

January 2019 – February 2022 Pittsburgh, PA

Managed payer contracting initiatives to improve network participation and reimbursement rates.

Negotiated and monitored credentialing agreements, ensuring regulatory compliance and operational efficiency.

Developed real-time dashboards for provider credentialing status tracking and contract execution.

Partnered with revenue cycle teams to resolve payer enrollment issues and optimize provider reimbursement.

UPMC, Chartwell Specialty Pharmacy

Reimbursement Billing & Collections Manager

January 2018 – December 2019 Pittsburgh, PA

Managed revenue cycle processes, achieving $2 million in savings by significantly reducing accounts receivable (A/R) days.

Ensured compliance with Medicare, Medicaid, and external reporting standards.

Managing accounts receivable (A/R) portfolios and reducing A/R days: Successfully managed multi-million-dollar A/R portfolios, implementing targeted strategies that reduced A/R days and improved cash flow.

Overseeing collections teams and mentoring staff: Led and mentored high-performing collections teams, enhancing productivity, accuracy, and compliance with payer regulations.

Improving billing and cash flow efficiency: Streamlined billing processes and implemented cost-saving initiatives that optimized cash flow and reduced revenue leakage.

CVS Health Specialty Incorporation

Cash Applications & Collections Manager (Workforce Reduction)

June 2017 – December 2017 Pittsburgh, PA

Conducted comprehensive internal audits and ensured compliance with SOX controls.

Improved financial reconciliation accuracy by 52% and streamlined cash management procedures.

Managing accounts receivable (A/R) portfolios and reducing A/R days: Successfully managed multi-million-dollar A/R portfolios, implementing targeted strategies that reduced A/R days and improved cash flow.

Overseeing collections teams and mentoring staff: Led and mentored high-performing collections teams, enhancing productivity, accuracy, and compliance with payer regulations.

Improving billing and cash flow efficiency: Streamlined billing processes and implemented cost-saving initiatives that optimized cash flow and reduced revenue leakage.

Managed vendor risk and compliance reporting, ensuring adherence to financial and healthcare regulatory requirements.

Created executive-level financial reports and issue resolution plans for leadership teams.

McKesson Corporation

Client Procurement Manager (Workforce Reduction)

August 2015 – February 2017 Pittsburgh, PA

Led credentialing and payer contracting initiatives, enhancing network participation efficiency from 67% to 99%.

Negotiated and structured provider contracts with key payers, ensuring favorable terms and compliance with healthcare regulations.

Implemented vendor credentialing workflows, reducing processing delays and improving contract turnaround time.

Partnered with executive leadership to implement the best practices in payer enrollment and reimbursement optimization.

Foundation Radiology Group

Billing Manager (Relocation)

September 2009 – April 2013 Pittsburgh, PA

Managed provider credentialing and payer enrollment processes, ensuring network participation across multiple states.

Led payer contract negotiations to enhance reimbursement structures and compliance.

Streamlined billing and collections processes, reducing claim denials related to credentialing discrepancies.

Provided expertise in Healthcare Information Management (HIM) coding and regulatory compliance.

Education:

Bachelor of Science: Business Administration (Coursework Completed, twenty credits remaining)

oAnthem College Online 2013 – 2015

Associate of Applied Science Anthem College Online (2006 – 2008- Graduated)

Certifications & Technical Skills:

Certified Physician Practice Manager (CPPM) 04/2014

PA Health Insurance & Life Certification 09/2023

Data Science and Business Analytics Maryland Institute (Expected 03/2025)

Proficient in Microsoft 365, Power BI, Tableau, SAP, MySQL, Smartsheet

Additional Experience:

Expertise in multi-state credentialing and payer enrollment, ensuring provider compliance with payer policies.

Strong leadership in mentoring teams on credentialing best practices, payer negotiations, and network participation.

Skilled in resolving payer escalations, troubleshooting credentialing-related denials, and optimizing provider reimbursement.

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