ØRecruit, Service and maintain a defined segment of high-profile professional, hospital, and ancillary providers and integrated delivery systems (IDS) in Pennsylvania and Delaware via on-site visits, provider telephone calls and/or written correspondence.
ØWork collaboratively with Contracting and Reimbursement to support decisions and negotiations during the contracting and re-contracting process.
ØDevelop and maintain professional and effective relationships with key functional areas within IBC; represent manager on corporate workgroups, as assigned.
ØIndependently organize and conduct initial orientations and routine meetings with these providers.
ØIndependently research and analyze the issues that impact these providers, including but not limited to issues regarding credentialing, contracting, claim payments, provider data file discrepancies, Medical Policy,Quality Incentive Payments (QIPS), capitation, utilization management, and other compliance initiatives.
ØConduct root cause analysis and work collaboratively with staff in other business areas to assist with the resolution of complex provider issues and achieve goals/outcomes within established time frames.
ØMaintain and update the appropriate tracking issues database with current statuses and next steps.
ØInformation gained during servicing activities to make recommendations to management regarding the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction.
ØEducate provider concerning new initiatives and changes in medical and claims payment policy and related operational procedures. Makes recommendations to management regarding changes to policy and procedures based on direct input from the provider community, IDS networks, and research gathered regarding standard industry practices.
ØEstablish and maintain professional and effective relationships with assigned providers to promote improvements in provider satisfaction and compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.
ØComplete assigned projects to support corporate initiatives within the timeframe set by Sr. Management.Perform a variety of additional duties as assigned.
Graduated with Honors
Graduated with Honors
Motivated Individual seeking employment in the San Fernando Valley and vacinity.
20 years of Provider Network Service Experience!
Do you have an open position within Provider/Client Services or Practice Administration?
Does this position need someone well versed in Networking, Contracting, and Process Improvement?
If so, I'm your new manager!
I am a service-oriented, analytical, forward thinking, problem-solver who will
be a strong organizational asset. Let me manage multiple priorities to stellar
outcomes with little to no supervision, or within a team. I have a proven
record of effectively interacting with all levels of management both internally and externally.
I am highly experienced in networking, claims analysis & processing, contracts and
operations, with a proven ability to conduct meetings on any scale from
small, using interpersonal skills to a multi-media approach in all operational
Please contact me so I may forward to you the following Recommendations / References:
ØSusan Bradley, Administrative Director, Crozer-Keystone Health Systems.
ØDeborah Hanchuruck, Director Physician Practice Mgmt Division III PA & NJ, Community Health Systems.
ØPaul R. Iverson, Managed Care Coordinator, St. Christopher’s Hospital for Children, Pediatric Associates
ØRonald Brooks, MD,Medical Director, Independence Blue Cross/IBC