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Street Address Gracelawn Ct. Telephone: PHONE NUMBER AVAILABLEBrentwood, TN Street Address EMAIL AVAILABLEWORK EXPERIENCECharacteristicsTeam player, energetic, enthusiastic, hard working, diligent, motivated, nimble, loyal HealthcarePrime Health Services, InterWest Health - June 2022 to Present. Provider Con- tracting Specialist InterWest Team Lead - The Provider Contracting Specialist is respon- sible for identifying, recruiting and contracting individual physicians, physician groups, ancillary facilities and other medical provider groups to join the PPO network. Negotiations will primarily be with physicians, physician groups and hospitals with a fo- cus on workers' compensation, commercial group health, auto liability and personal in- jury, with defined reimbursement expectations.Contracting efforts will be based primarily upon client nominations. This position requires successful recruitment of medical providers to join the PPO net- work.Additionally, this role requires skills to obtain contractual reimbursement rates contained within clearly defined parameters, per product, that meet or exceed industry expecta- tions.Essential Job Functions Negotiate managed care PPO contracts, ensuring a cost effec- tive contract in compliance with all State, provider, and corporate requirements Negoti- ate PPO contracts with independent hospitals and health care systems Analyze data to develop strategies for contracting and re-contracting Call/email medical providers for contracting Develop and maintain relationships with key medical providers at the direc- tion of the Director of Network Development Enter all progress reports and any nota- tions regarding contracting efforts into Prime's proprietary database The Provider Con- tracting Specialist may be asked to travel for PHS purposes. Travel will range from less than 20% to 50%, depending upon experience level and contracting assignments.Fresenius Medical Care Health Plan - January, 2009 to September, 2009. Regional Insurance Sales Sold a multi-state territory including northern Alabama, middle Ten- nessee and central Illinois for ESRD (end stage renal disease) Medicare Part-C chronic illness Medicare Advantage PFFS (private fee for service) plan operating under a waiver from CMS. Developed and maintained professional relationships with nephrologists practice and physicians, dialysis clinic administration (RVP, area managers and clinic managers), clinical social workers & dietitians. Consulted with eligible hemodialysis, home hemodialysis and peritoneal dialysis patients to enroll them in the plan as appro- priate. Observed all CMS, FMC, FMS and FMCHP rules, sales and marketing compliance rules and policies. Generated highly competitive enrollment numbers with the highest retention statistics. Repaired damaged brand and re-opened territory in Alabama. Opened still-born territory in Illinois.HEOPS September, 2011 - June, 2013. Network Contracting, Provider Recruiter From a shared Excel provider database contact targeted providers, introduce the RFP for managed care services by the state (LA, OR, FL, OH, Nationwide), forward LOI/LOA, explain benefits of participation and close the commitment by the provider to partici- pate. Once the proposal is awarded by the issuing state, forward contract, explain the terms of the contract, answer questions, negotiate if required and ask for a signature or pass provider to the large entity negotiating team. Follow up where necessary. Receive document, log document, chase missing information/credentialing until the contract package is complete.Provider ContractingCIGNA (Kelley Services) - December, 2017 - May, 2018. Network Contracting and Cre- dentialing Receive nationwide inbound calls to initiate, verify and troubleshoot contract- ing and credentialing for providers, practices and facilities. Research case to explain sta- tus. Refer to relevant TPV or Cigna department.PsychologyThe Ranch Tennessee - November, 2021 - April, 2022 Admissions Specialist Received written pre-Admission Assessments from the call center and vetted the poten- tial client for suitability for Dual eligibility, Substance Abuse, Mental Health or the Sexual Recovery Programs. Occasionally passed the assessment up to MD or PhD (clinical) for review, if very complex or questionable. If the client was acceptable, requested a Wrap- up after finding a bed for the proper date, program and house. Held the bed. Worked in three real-time Excel spread sheets, Set-up and completed charts in KIPU and referred to and updated Sales Force charts, ran payments and set up payment plans in Paymen- tus. Performed Alcohol swab and breathalyzer tests, administered pregnancy tests, per- formed BD Meritor COVID-19 tests and logged results. Administered 14 panel UDS tests and logged the results.Cumberland Heights - December, 2020 - October, 2021 Clinical Associate, Second shift, full time. Led 12 step meetings, let group discussions, led large group discussions, ran work shops, led new patient orientations, monitored a cabin in the evening, con- nected with patients individually on their experience and processing work, searched cabins when indicated, participated in gown searches, herded cats. Cumberland Heights - July 2019 - December, 2020 PRN Residential Assistant working across three shifts as needed.Life Insurance:Zander Insurance - November 2019 - December 2019 Sales Sell term life insurance through out the US telephonically.Pate Priority Life - April 2019-November 2019 Sold Life Insurance through out middle Tennessee representing 14 companies.Franklin Madison Insurance (Randstad) - February 2019 - March 2019 Claims Inbound and outbound calls regarding claims for AD&D, Accidental Hospitalization and Accidental Recuperation policies.Human Resources:Hospital Corporation of America (CSI) - January 2019 - February, 2019 High volume appointment setting for telephonic and in person interviews. Empyrean (Randstad) - September, 2018-December, 2018. Human Resource Services Receive inbound and make outbound calls to advise and enroll employees of Frontier, Hanes Brands, Olympus, Williams, Arch Coal, Universal & Childrens Hospital regarding options for their company benefits during Life Events and Annual Enrollment. We use Empyrean CRM, MS Office Suite, Proprietary Time keeping software, IWS (telephone application), Firefox and Chrome.Technical Support:Apple, Inc. - March, 2016 - November 2017. Promoted to OS X Senior AHA Advisor. Successfully completed all training including CS Codes, CRUs, RTAs, Escalated calls, T-2 Managers Escalations, Commitment Tracker, Appeasements, iCloud Support App for T-2, iLog, Web Payment. Had managerial powers and supported T-1 advisors who needed guidance. Negotiated for appeasements with customers who felt that they had been wronged by the company. Negotiated for ineligible warranty work with customers with and without expired Apple Care Protection Plan coverage. Negotiated with customers for writing Customer Replacement Unit device replacements. Wrote requests for techni- cal assistance from the Site Support Engineers and liaised with same on behalf of cus- tomer.Apple, Inc. - December, 2015 - November 2017. Promoted to Tier-2 iOS Senior AHA Advisor. Successfully completed all training including CS Codes, CRUs, RTAs, Escalated calls, T-2 Managers Escalations, Commitment Tracker, Appeasements, iCloud Support App for T-2, iOS Syncing lab for T-2, iLog Web Payment, Tier-2 Advanced iOS 1 & 2. Owned increased responsibility of supporting T-1 advisors who need guidance and ne- gotiated for appeasements, for ineligible warranty work and for writing Customer Re- placement Unit device replacements and writing requests for technical assistance from the Site Support Engineers.Apple, Inc. - June, 2015 - December 2015. Promoted as Tier-1 iOS Technical Support AHA Advisor. Trained on Apple Watch, Apple Pay, Cross Functionality, Apple Watch OS 2 EN, iOS 9, Apple ID, Apple Music, Photos, Pages, Numbers for iOS. Successfully com- pleted all Apple training. Provided excellent technical support to customers by telephone using screen sharing where possible. Metrics at or above the role. Apple, Inc. - April, 2014 - June, 2015. Continued as Tier-1 CPU Technical Support AHA Advisor. Trained on OS X 10.10, Chat T-1 CPU, A A A, 12 inch Mac Book, Apple Watch, Apple Pay, Cross Functionality, Apple Watch OS 2 EN, Yosemite EN, El Capitan, iOS 9, Apple ID, Apple Music. Successfully completed all Apple training. Provided excellent technical support to customers by telephone using screen sharing where possible. My metrics remain at or above the role.IBEX Global - June, 2013 - December, 2013. Technical Support I Advisor Passed all CPU training. Performed role of inbound troubleshooting issues with MacBook, MacBook Pro, MacBook Air, iMac and Mac Pro running OS X 10.6, 10.7, 10.8, 10.9, 10.10, 10.11, 10.12. Helped customers with OS X upgrades through 10.12. Proficient with taking cus- tomers to Apple.com and locating the product or service that they have an interest in for purchase. Reset Apple ID passwords. Performed Account security via iCloud Support web site. I am proficient in transferring customers to correct department and tier, based upon their request or requirement with in the organization and based upon Scope of Support for the role. I am proficient with K Base and researching solutions in approved internal and external fact based articles. Apple Connect ID, Sparks, Screen Sharing(Bomgar), iLog, Monster Board (MB4 & MB3), UltiPro-financial information, TKS (TRG Portal)-Hours, Total View (IEX)-Schedule, Outlook-Email, iCloud, iCloud Support appli- cation.EducationUniversity of Rochester - Rochester, NY. B.A. Economics 1990. |
