SUMMARY OF QUALIFICATIONS
Highly passionate and experienced healthcare professional committed to enhancing clinical functions and streamlining more effective administrative activities. Strengthen relationships with team leaders and establish physician and team member training protocols.
Operational Development
Strategic Market Research
Claims Research
Contract Negotiation
Knowledge of different reimbursement methodologies
Healthcare Administration
Managed Care
Commercial/Medicare/AHCA/HIPAA
Physician Training
Healthcare Network Oversight
Network Contracting and Service
Team Leadership
Create accountability
Relationship Building
Manage and Motivate Staff
Inquiry Management
Clinical Outcome Assessment
PROFESSIONAL EXPERIENCE
Manager of Value Based Relationships | AvMed Health Plan, Miami, FL 11/2019 to Present
Responsible for managing various functions integral to Value Based contracting initiatives and aligning provider strategy with payer goals. These functions include Value Based contracting initiatives; performance reporting; management of MSOs; and improvement of payer’s network performance in quality, affordability and member satisfaction.
• Establish strong relationships with Value Based partners (MSOs, Health Systems and independent PCP offices) to improve quality of care, financial performance, and patient satisfaction for AvMed members who are assigned to Primary Care physicians (Medicare and Individual/Small Group).
• Possess in-depth knowledge of clinical quality metrics, Shared Savings models, Value Based contracting (including partial/full risk & gain share), performance scorecards and other quality reporting.
• Develop training materials related to AvMed resources (FRG, Qlik, Provider Portal) and maintain understanding and use of AvMed data resources (HealthEdge, Vistar, Macess, and BIE Data warehouse).
• Manage and contribute to JOC meetings; participate in STARS/HEDIS/CAHPS and other committees working in conjunction with Quality, Analytics, Government Program Revenue and Finance to drive necessary data reporting to support the Value Based relationship.
• Direct reporting relationship over set of employees including Senior Contractors, Value-Based Coaches and Value-Based Physician Representatives.
Global Analyst | Nicklaus Children’s Health System, Miami, FL
Responsible for streamlining financial services, workflow systems and processes for international patients, internal providers, and the global health department. Maintain fruitful relationships with internal and external clients to increase business profitability and improve delivery of healthcare services.
● Model contracts for internal and external clients to determine reimbursement rates for health services provided to international patients.
● Function as Global Data Analyst to conduct financial analysis by generating trends, reports and analyzing workflow systems.
● Serve as liaison between Finance, Revenue Cycle and Global Health to align effective business practices between stakeholders and departments.
● Handle from beginning to end all billing and payment reconciliation for international patients.
Significant management changes prompting my departure.
Provider Relations Specialist | Managed Healthcare Partners, LLC, Miami, FL
Spearhead negotiation of managed care contracts –full and partial risk –to bolster business profita...
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