HEALTHCARE CONSULTANT Summary Certified Spinning Instructor personal trainer energy, skills training necessary keep clients motivated moving toward fitness goals. Highlights Certified Spinning Instructor ACE certified Personal Trainer CPR First Aid certified Energy, motivation drive push motivate participants. Microsoft Office Team building Personable friendly Dedicated Responsible Accomplishments Success building participants struggling, low participant classes. Most recently built class averages 30 participants class started around 6 within six months. Experience Healthcare Consultant October 2014 Current Company Name － City State Network development new Medicare Advantage I-SNP northeast. Identify contract providers establish network meets CMS time/distance standards. Subject matter expert study Medicare Advantage best practices provider engagement. Cycle Instructor September 2012 Company Name － City State Provide high-energy, safe indoor cycle experience participants. Lead, motivate push participants. Prepare new routines new music weekly ensure participants get bored uninspired. Incorporate various types formats classes (Tabata HIIT, interval resistance training, speed work). Provider Group Engagement Manager September 2012 October 2014 Company Name － City State Responsible establishing, maintaining overseeing various MSO engaged provider relationships Oversaw directed MSO partner activities internal implementations order ensure successful launch gated, referral-based provider network Atlanta market. Initiated provided ongoing support financial performance data various strategic relationships, including MSOs, PCP practice acquisitions, direct provider engagement agreements clinic developments. Coordinated provided detailed analysis, reporting, training, education large, engaged provider groups order promote improvement clinical, quality, coding financial performance. Successfully facilitated implemented various initiatives provider groups around HEDIS, STARS, etc. Served contact provider risk group questions regarding financial settlement, delegation, claims adjudication funding. Managed directed staff 4 Provider Network Consultants. Lead directed committee responsible improving employee engagement within Southeast Region. Regional Director September 2010 April 2012 Company Name － City State Network Services Southeastern Region Responsible managing directing contracting provider relations activities within Southeast Identified executed strategies network development improvement. Managed directed regional contracting provider relations staff. Provided in-depth knowledge Southeastern region participated strategic planning. Managed oversaw complex contract negotiations. Identified new areas expansion conducting in-depth market financial analyses. Maintained positive relationships providers facilitated prompt resolutions contractual issues. Manager, Managed Care January 2004 January 2010 Company Name － City State Responsible negotiation maintenance major managed care contracts, well managing WellStar's credentialing department. Negotiated favorable contract language rates meet business targets objectives Georgia's largest integrated healthcare system, consisting five hospitals, ancillary services, 1000 affiliated physicians. Increased profitability three key payor contracts 20% system. Maintained contractual relationships facilitated resolution problems arising contract. Managed allcredentialing department activities staff. Implemented processes procedures shorten enrollment process government payors, cut enrollment time average 50 days. Successfully obtained delegated credentialing contracted payors, resulted 100% delegation average 90 days shorter loading time payors. Consistently averaged 99% delegated payor audit scores. Continuously implemented developed strategies improve drive employee satisfaction. 2010 Gallup surveys indicated 48% increase employee satisfaction two years Managed Care department. Developed implemented improvements best practices credentialing department order align system goals. Implemented "Lean Thinking" techniques credentialing department streamlined processes, facilitated transparency led better overall satisfaction department. Provider Reimbursement Specialist January 2000 January 2004 Company Name － City State responsible implementation quality assurance various provider contracts successfully Blue Cross Blue Shield GA's computer system assisting system-wide initiatives. Managed internal reimbursement-related activities multi-million dollar monthly capitation payment process, including analysis, implementation reporting capitation data. Collected analyzed provider contracting data computer system data ensure timely accurate reimbursement implementations. Performed quality assurance measures reimbursement implementations. Identified recommended system modifications advance provider contracting strategies best practices. Managed multiple reimbursement projects determining business intent, estimating communicating implementation timetables parameters, distributing project results final documentation. Served capitation subject matter expert development WellPoint Enterprise Data Model. Senior analyst January 1997 January 1999 Company Name － City State responsible implementation various provider contracts successfully Blue Cross Blue Shield GA's computer system. Developed distributed professional fee schedules based Medicare rates. Produced ad hoc reports analyses management reimbursement data provider database content. Presented project results recommendations management project teams. Created project documentation reports distributed throughout organization. Loaded contracts Pathways Contract Management system. Provided leadership training department ten. Health Systems Analyst January 1997 January 1999 Company Name － City State Responsible implementation various provider contracts successfully Blue Cross Blue Shield GA's computer system. Implemented preferred reimbursement methodologies (physician, facility ancillary). Managed multiple projects collaborated teams achieve results. Report Specialist January 1996 January 1997 Company Name － City State Responsible reporting quality data. Client Services Representative January 1995 January 1996 Company Name － City State Responsible assisting clients authorizations insurance questions. Education Master Business Administration Bachelor Science Business Administration/Management Health Services Administration 2000 Kennesaw State University － City State USA Bachelor Science Health Services Administration 1994 Auburn University － City State USA Skills acquisitions, CMS, content, contract negotiations, contracts, Contract Management, clients, database, directing, documentation, estimating, financial, government, insurance, leadership training, managing, market, negotiation, Enterprise, Network, processes, coding, quality, quality assurance, reporting, strategic, strategic planning