results-focused health care executive eager to contribute proven network development, operations management, team building, and customer service abilities, as well as ipa / pho negotiations expertise to facilitate

optimal risk-sharing agreements, toward supporting a company in maximizing bottom-line profits.

profile

 

         contribute sharp business negotiations skills, dynamic presentation proficiencies, and successful interpersonal relationship-building techniques, along with providing excellent written and verbal communication talents.

         able to build critical organizational relationships and valuable professional networks.

         expert at securing provider retention by facilitating intelligent profit objectives and providing outstanding customer service, as well as by actively developing new business opportunities for continued marketplace dominance.

 

~ education ~

 

masters of public administration                                                                                             city university of new york, baruch college

bachelor of arts in business administration                                                                                                                                              hofstra university

professional synopsis

 

united healthcare of new york, inc., new york, ny

 

~ key business achievements ~

 

ø increased provider network size by 15% annually over three years through profitable negotiations with ipas and phos, along with facilitating medical costs decreases by 3% for a savings of $5 million.

ø successfully developed, negotiated, and implemented a strategic orthopedic case management initiative that reduced specific costs by 15% within initial 18 months.

ø conducted proficient fee schedule analysis and implemented smooth conversion to cost-effective rbrvs methodology of reimbursement for over 30,000 physicians.

 

regional manager risk relations (2000)

 

         applied leadership talents toward directing comprehensive physician network expansion efforts within the metropolitan new york city area by negotiating profitable capitated ipa risk-sharing and fee-for-service agreements, along with managing a top-performing staff of risk contractors.

         contributed strong business analysis and critical thinking skills instrumental in initiating long-term strategies for assigned risk arrangements, as well as develop solid deal structure and action plans for execution.

         coordinated and analyzed monthly performance reports for executive-level management review that effectively summarized key financial performance indicators (kpis) status.

         liaised with internal regulatory management personnel to ensure optimal doh and hcfa compliance, along with organizing and submitting organizational responses to requests for information (rfis).

         participated in quality improvement, network medical management, and compliance and appeals committees.

 

risk sharing consultant (1996 c 2000)

 

         maximized operational profits by expertly negotiating and implementing full- and shared-risk agreements with ipas and phos, along with coordinating business efforts with providers, claims payment, utilization management, and legal / provider services departments to ensure seamless contractual processes at all times.

         demonstrated solid presentation and interpersonal relations abilities toward presenting risk model proposals to targeted groups, as well as manage business relationships and provide data at key quarterly meetings.

 

provider relations representative (1995 c 1996)

 

         developed and maintained a quality provider network ensuring accessible and cost-effective care delivery to all members by accurately analyzing and identifying organizational plan needs and profitable opportunities for additional service relationships and expense reductions.

         performed lucrative contract negotiations and monitored providers and contractors to verify that cost control targets were achieved, as well as respond to ipa, pho, and individual providers to resolve wide-ranging claim issues.

         initiated critical credentialing and re-credentialing procedures according to corporate policies, along with conducting site visits to assess strict compliance with national committee of quality assurance (ncqa) standards; created and presented corporate policy / procedure orientations to providers and staff.

 

~ additional professional roles held prior to 1995 ~