Senior Managed Care Network Executive
Resume:
ANGELITA COLEMAN
Randallstown, MD 21133
***********@***.***
Cell: 410-***-****
SUMMARY OF QUALIFICATIONS
Results-oriented senior executive with advanced experience in managed care. Extensive physician, ancillary and hospital contracting experience coupled with proven provider relations management skills. Health care industry expertise in the areas of strategic planning, value- based contracting, network management, and operational solutions. Skilled in the advancement of Episodes of Care as a value-based approach for primary and specialty care. Well able to advocate for Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality & value-based models. Proven ability to cultivate functionally collaborative relationships between payers and providers achieving the triple aim. Culturally competent change-oriented, transformative leader adept at creating and managing clinically integrated networks. Proven healthcare management consultant, helping companies translate their business goals to reality. ACCOMPLISHMENTS AND EXPERTISE
• Successfully re-contracted provider network following two major acquisitions acquiring cost savings.
• Assisted with development of Patient Centered Medical Home and day to day operations.
• Contributed to the success of opening the 1st Health Cooperative under the ACA in Maryland.
• Successfully negotiated & implemented EOC/BP as a strategy to migrate from FFS to quality & value-based models that reward providers for excellent outcomes and patient satisfaction, while reducing overall healthcare cost. PROFESSIONAL EXPERIENCE
AMERIHEALTH CARITAS DC, NETWORK MANAGEMENT 4/2023 –present
• Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers.
• Negotiate contractual agreements with hospitals, FQHCs, home health agencies including infusion, ASCs, SNFs and physicians.
• Maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.
• Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products.
• Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.
• Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.
EWING, INC., SENIOR CONSULTANT Contractual 5/2022- 11/2022
• Assist clients with deploying scalable provider network solutions for the healthcare and insurance industries.
• Successfully deploying network development solutions and launching new products.
• Pursuing and delivering on large-scale contracts.
• Efficiently managing networks including the implementation of value-based programs and effectively responding to the expending requirements of a geographically dispersed customer-base. CAPITAL WOMEN’S CARE, DIRECTOR OF CONTRACTING MIDATLANTIC REGION 4/2019-8/2021
• Responsible for the overall direction, strategy, and design of Capital Women’s Care’s Episodes of Care/Bundled Payment Program for obstetrics and gynecology.
• Negotiate renewals and other contract negotiations.
• Advocate for Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality & value-based models, rewarding providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
INDEPENDENT CONTRACTER/PART/UNEMPLOYED 5/2016-4/2019
• Direct teams in managing physician contracting, network development, provider relations and provider operations.
• Graduate Student/Daycare provider/Hospice Care Provider. ANGELITA COLEMAN
9414 Tulsemere Road
Randallstown, MD 21133
***********@***.***
Cell: 410-***-****
Page Two
GATEWAY HEALTH PLAN, SENIOR CONSULTANT, Pittsburgh, PA 4/2015 – 4/2016
• Responsible for all facets of provider contracting and network development in Pennsylvania and the expansion states of North Carolina, Ohio and Kentucky including administrative operations.
• Responsible for managing staff and day-to-day department operations including policy development and continuous process improvement.
• Contributions to Medical Economic Initiatives and special projects. EVERGREEN HEALTH COOPERATIVE INC., Baltimore, Maryland 3/2013 – 12/2014 Vice President, Provider Relations and Network Administration
• Responsible for all facets of network development, provider relations, and provider maintenance.
• Policy development consistent with regulatory and accrediting authorities.
• Oversight of vendor relations & benefit administration.
• HIX experience including preparation for participation with Maryland Health Benefit Exchange.
• Assisted with the development, implementation and day to day administration of 4 PCMHs. AFFINITY HEALTH PLAN, INC., Bronx, New York 3/2011 – 3/2013 Senior Consultant, Provider Contracting and Provider Relations
• Successfully renegotiated hospital agreements from APR to AP DRGs allowing the benefit of trim points.
• Lowered cost by expanding freestanding ambulatory surgery network moving services away from outpatient hospital setting.
• Developed an adequate network to support New York State's new Health Home product.
• Oversight for Health Care Exchange, Medicare FIDA, and MLTC expansion and SNP.
• Negotiated gain share, bundled payment and full risk agreements. KAISER PERMANENTE, MAS, Rockville, Maryland 8/2008 –3/ 2011 Senior Contract Manager, Provider Affairs
• Managed provider contracting functions for two states resulting in an average savings of over
$250K per quarter, $1.1M annually.
• Supervised a department of four direct reports responsible for all ancillary, group practice contracting and provider relations functions including payment resolution, contract implementation and administration.
• Negotiated preferred provider agreements with two specified vendor types at a cost savings of $1.2M annually (vision and cardiology).
• Collaborated with Medical Management to develop case management agreements designed to prevent repeat admissions and acquire a cost savings to the health plan.
• Participated in development and implementation of new contract and payer delivery system. AMERIGROUP Community Care, District of Columbia 11/2007-8/2008 Associate Vice President, Provider Relations
• Successfully participated in the re-bid process securing a 5year Agreement with the Medical Assistance Program in the District of Columbia.
• Successfully developed, implemented, and managed provider network to service Medicaid population.
• Served as direct liaison between the Health Plan and Medical Assistance Association.
• Successfully negotiated facility, ancillary and physician contracts expanding and stabilizing the network. AMERIGROUP Community Care, Director, Network Development Maryland 1/2007-11/2007
• Successfully negotiated ancillary contracts expanding and stabilizing the network for Medicaid & Medicare product lines.
• Re-contracted with entire Ambulatory Surgery Center network to align with the then current CMS payment methodologies at a cost savings of over $634K.
• Negotiated preferred provider agreements with specified vendor types designed to lower re-admissions and acquired a cost savings to the Health Plan (HIV and congestive heart failure).
• Supported development of recovery packages collaborating with analytics, policy analysts and SMEs
• Managed Provider Network staff of 6.
ANGELITA COLEMAN
9414 Tulsemere Road
Randallstown, MD 21133
***********@***.***
Cell: 410-***-****
Page Three
UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC., Rockville, Maryland 2/2004 –1/2007 Senior Network Account Manager
• Successfully re-contracted provider network following major acquisition and acquired cost savings each quarter (average savings per quarter $210K, top savings per quarter, $581K).
• Expanded and stabilized provider network for both Commercial and Medicaid lines of business.
• Facilitated providers’ understanding of contract language, products, policies and procedures.
• Participated in the development, conversion and implementation of a new contract database.
• Managed Provider Network staff of 5.
MID ATLANTIC MEDICAL SERVICES, INC., Rockville, Maryland 7/2001 –2/2004 Manager, Provider Networks
• Recruited, developed, and maintained an adequate network of providers in assigned geographic areas.
• Re-negotiated contractual agreements with Ambulatory Surgery Centers and Skilled Nursing Facilities
• Facilitated providers’ understanding of Plan products, objectives and policies and procedures.
• Monitored and ensured provider contract compliance as well as adherence to administrative Plan protocols.
• Efficiently handled provider inquiries, including research, resolution, and response.
• Manage Provider Network staff of 6.
UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC., Baltimore, Maryland 2/1995 –7/ 2001 Manager, Provider Relations
• Planned, developed, and implemented operational policies and procedures designed to improve the flow of communication in a collaborative manner and to enhance the overall health care delivery system.
• Analyzed and designed educational products to accomplish goals as directed by the local Care Advocacy Council utilizing physician profile reporting, patterns of treatment, clinical profiling, and other tools.
• Managed the implementation of the Health Plan’s reimbursement and recruitment strategies in conjunction with the Medical Expense Team, using tools such as geo access reports and financial reports.
• Analyzed and evaluated the effectiveness of managed care programs, constantly evaluating performance against industry standards and making recommendations on how to improve current programs. EDUCATION
Master’s Healthcare Administration, University of Maryland Global Campus BA, Health Science and Policy, Health Services Administration Concentration, University of Maryland Certificates and course descriptions available upon request. References available upon request.
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