Microsoft Office, Salesforce, contract negotiation, Excel

Phyllisia Weeks

*** ******* ** **********, ** *5214 205-***-**** – Phone E-mail: ********@*******.***

Education

Troy University - (In Progress) Troy, AL Master of Strategic Management

Faulkner Christian University - Graduate Birmingham, AL Bachelor of Business Administration

Dynamic and results-oriented healthcare professional with over 10 years of experience in provider network contracting, management, and development. Expertise in negotiating contracts with hospitals, specialists, IPAs, DME providers, home health agencies, mental health vendors, and laboratories to ensure network adequacy, compliance, and cost-effectiveness. Proficient in credentialing, reimbursement methodologies, provider relations, claims processing, appeals, and value-based payment models (including MIPS, MSSP, and bundled payments). Skilled in building strong relationships with primary and secondary payers, analyzing provider data, resolving billing discrepancies, and driving operational efficiencies. Strong communicator with a proven track record in Medicare/Medicaid billing, HIPAA compliance, and cross-functional collaboration. Adept at using tools like Excel, Domo, Google Suite, and internal systems to track contracts, generate reports, and support decision-making in fast-paced environments.

Core Skills

Contract Negotiation & Development

Provider Network Management & Recruitment

Credentialing & Re-Credentialing

Claims Processing, Appeals, & Denials Management

Reimbursement Methodologies (Value-Based, Bundled Payments)

Provider Relations & Relationship Building

Compliance (HIPAA, Medicare/Medicaid Regulations)

Data Analysis & Reporting (Excel, Domo)

Project Management & Team Leadership

Customer Service & Stakeholder Communication

Professional Experience Cigna Health

Contract Service Analyst Remote 2022 - Current

Negotiated and managed contracts for healthcare providers and facilities, ensuring compliance with pricing, discrepancies, and reimbursement terms while collaborating with legal and credentialing teams for approvals and signatures.

Developed procedures for efficient contract administration, including filing, management, and professional purchasing practices to support supply chain and value enhancement programs.

Analyzed cost data, identified savings opportunities, and implemented projects to negotiate new product requests and optimize contract terms.

Maintained detailed billing and claims records in compliance with HIPAA, analyzed errors to minimize denials, and maximized reimbursements through accurate data entry and system updates.

Provided client support in service, maintenance, and penetration, responding to inquiries, resolving issues, and coordinating with account managers to avert problems and expand business opportunities.

Monitored project timelines, coordinated schedules, and supported onboarding/training for team members to ensure timely deliverables and seamless workflows.

Offered guidance and coaching to junior team members, drafted documents, and generated initial reports/analyses for review, emphasizing attention to detail and quality control.

Participated in internal reviews of contract terms, including change orders and liability, while ensuring accurate documentation and compliance reporting.

HEOPS Healthcare

Contract Network Development Manager Remote 2021 – 2022

Led contracting and network development initiatives, ensuring network adequacy through reimbursement methodologies, credentialing accuracy, and provider relations to support health plan partnerships.

Served as liaison between health plans and providers (hospitals, specialists, IPA groups, DME, home health, mental health vendors, laboratories), building strong relationships and resolving operational inefficiencies.

Recruited and negotiated contracts with providers including optometrists, DSOs, ophthalmologists, home health agencies, LTC facilities, nurse registries, ADCs, pharmacies, PSAOs, and independents across multiple states.

Inspected contracts for compliance with certification requirements, laws, regulations, policies, and procedures; communicated with Medicare representatives to resolve billing discrepancies and obtain claim updates.

Performed credentialing for managed care and medical group organizations, handling 50-60 cold calls daily to recruit, contract, and retain providers and facilities.

Analyzed provider data, generated reports/metrics for decision-making, and created provider-sponsored networks in Medicaid programs.

Promoted to lead network manager on Georgia project, overseeing recruitment, contracting, and retention strategies.

Proficient in MIPS, MSSP, value-based, and bundled payments.

Aetna Health Birmingham, AL

Health Advocate Remote 2020 – 2021

Handled customer inquiries on pre-authorizations, financial assistance, appeals, denials, and follow-ups within Aetna's platform, educating members on PPO, HMO, Traditional Choice, and HNO plans.

Researched electronic files, imaged records, and systems (MCS, Fiscal Intermediary Standard System, Medicare Appeals System) to resolve issues, verify eligibility, and process claims referrals, grievances, and appeals.

Documented and tracked credentialing/re-credentialing for doctors, providers, and medical groups; assisted providers with self-service options and re-credentialing processes.

Guided members through benefits, policies, and resources while building trusting relationships; anticipated needs, provided additional plan details, and used customer service frameworks for financial decisions.

Processed claims using COBRA, nurse reviews, complaints, and internal referrals; determined medical necessity, coverage, and eligibility with knowledge of ICD-9/ICD-10 codes.

Performed reviews of claim history for benefit maximums, coinsurance/deductibles; handled Medicare/Medicaid appeals/pre-authorizations not managed by clinical teams.

Assisted in complaint trend reports, claim data compilation for audits, extensive file reviews, and random audits; responded to litigation requests from Aetna's Law Document Center.

Utilized Google Suite (Sheets, Docs, Forms, Calendar) for scheduling, reporting, and remote collaboration; demonstrated excellent phone, email, and instant messaging skills.

Social Security Administration Birmingham, AL

Team Lead, Claims Coordinator 2014 – 2020

Led a team in processing Social Security, Medicare, and Medicaid claims, including Part D prescriptions; explained EOBs, coordinated benefits, and resolved overpayments via garnishments/bankruptcy reviews.

Provided technical support, leadership, and training to customer service representatives on SSA rules, policies, Avaya systems, and quality assurance to ensure uniformity and minimize errors.

Conducted inquiries/interviews to verify beneficiary eligibility; researched databases (MCS, MAS) and Microsoft applications to analyze data, determine status, and process claims/post-entitlement actions.

Monitored workloads, performed random audits, and analyzed training needs to build recommendations for process improvements and successful metrics.

Managed staff through selection, development, mentoring, and performance management; provided feedback on audit results and empowered team for high performance.

Offered knowledge of services for elderly, blind, disabled beneficiaries from government/private agencies; researched multiple sources to investigate information and enhance SSA programs.

Received Commissioner's Exceptional Customer Service Award in 2018 for outstanding contributions in claims coordination and customer support.

Utilized Google Suite (Sheets, Docs, Forms, Calendar) for scheduling, reporting, and remote work; excelled in phone, email, and instant messaging communication.

Awards & Certifications

Commissioner's Exceptional Customer Service Award, Social Security Administration (2018)

Federal Basic Clearance

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