Business Development Liaison Resume Example Ohio Living

BUSINESS DEVELOPMENT LIAISON

Professional Summary

Business development liaison experienced in all aspects of provider recruitment, marketing, and contract negotiations. Experienced in effectively building loyalty and long-term relationships with physicians, and hospital staff while consistently increasing the amount of new provider referrals and admissions.

Skills

Business Development
Marketing
Provider Recruitment
Network Operations
Contract Negotiations
Credentialing
Business Plan
Performance Metrics
Effective negotiator
Customer satisfaction
Marketing strategy

Planning and development
Analytical thinker
Knowledge of Medicaid statutes and regulations
Budget forecasting

Market Analysis

Relationship management
Excellent listening skills
Highly organized
Critical and creative thinking
Revenue and profit maximization

Work History

Business Development liaison, 05/2009 to Current
Ohio Living – Waynesville , OH

Marketing strategic efforts building relationships with physicians, hospitals case managers, discharge planners, social workers, for new referral sources.
In charge of contract negotiations with commercial, PPO, POS, Workers Comp, Medi-cal, and Medicare advantage Health plans, physicians, ancillary, and specialty providers.
Evaluated current healthcare reimbursement rates for renegotiation purposes.
Accountable for monitoring physician, and hospital referral patterns and trends.
Network with key hospital referral sources, physicians, payer sources and the community to increase referrals, and admissions. Maintain relationships with key referrals sources, and continue to build new relationships.
Develop marketing collateral for brochures, handbooks, news paper, and magazine advertisement, presentation materials ,special events, radio advertisement, and television.
In charge of educating hospital staff, physicians, and the community about programs and services. Providing presentations to referral sources. Participating in community events, Expo's, health fairs, seminars, and conferences.
Work closely with internal staff to develop new processes and standards.

Managed the business development financial spend down reporting, contracting, marketing strategies, physician recruitment.

Led the planning and achievement of goals and objectives consistent with the agency mission and philosophy.

Provider Network Representative, 01/2007 to 01/2009
Apex Systems – Little Rock , AR

In charge of provider recruitment and contracting by identifying and targeting specific providers within their assigned territory for contracting, facilitation the distribution of provider agreements, negotiating rates for new physicians, and renegotiating contracts for existing physicians within established limits. Serve as subject matter expert to other department staff.

Developed strong interpersonal provider relationships. Resolved escalated provider inquiries within contract guidelines. Educated providers on new protocols, policies, and procedures. Promotes provider adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
Organized, coordinated, and conducted PCP and office manager forums, provider in-services, and provider office visits to increase membership growth.
Interfaced with internal departments to analyze, review, and tender recommendations for provider contracts, health-plan contracts, quality improvement initiatives, care management issues, capitation and claims payment issues, encounter data submissions, eligibility issues, and marketing plans.
Monitored solutions for cost-effective provider contracting limits use of non-contracted providers, and controlled use of non-capitated and non-preferred providers.
Developed and negotiated IPA contracts, and tracked their performance (volume, service, quality, and profitability) by analyzing monthly financial statements, claims, and stop-loss detail reports.
Initiated corrective action plans as necessary.
In charge of IPA Board of Director, UM, and QI meetings.

Contracts Administrator, 09/2006 to 06/2007
Unitedhealth Group Inc. – Lancaster , TX

Conducted an analysis of our network for deficiencies by negotiating primary care, specialty, and ancillary provider contracts and/or letter of agreements.
Processed termination letters, acknowledgement letter to ensure ample time to notify providers and members.
In charge of writing contract summaries to provide clarity of contractual arrangements.
Build provider reimbursement structure for claims processing.
In charge of contracts, cover letters, letter of agreements, and termination letters while maintaining department standards.
Accountable for the daily claims and utilization report to initiate and obtain letter of agreements at a cost savings rate, which resulted in 150,000 savings to the company within a six-month period.
In charge of growing and maintaining relationships with primary care, specialist, health plans, and ancillary providers.
Spearheaded expansion and development initiatives in Inland Empire.

Provider Services Representative, 06/1997 to 08/2006
UNIVERSAL CARE – City , STATE

Monitored network adequacy and developed strategies to enhance the network.
In control of the dissemination of policy communications to contracted medical groups, hospitals, and providers.
Maintained new and existing provider relationships to promote the efficient delivery of services to providers.
Initiated resolution of contractual and provider concerns, including service issues related to eligibility, claims, capitation, credentialing, encounter data, and member benefit programs.
Facilitated and performed pre-contractual site review audits for primary, and specialty care providers.
Scheduled and instructed primary care provider staff on policy and procedures, timeframes and state standards.

Implemented and evaluated ongoing provider education. staff orientation programs based on contract benefit and regulatory requirements.

Chaired quarterly Joint Operations meetings. Served on the Medicare Oversight committee as the Provider Business Representative.
Led the planning and achievement of goals and objectives consistent with the agency mission and philosophy.

Education

Bachelor of Science: Healthcare administration, Current
California Coast University - City

Associate of Science: Healthcare Administration, 2014
University Of Phoenix - City, State

Resume Overview

School Attended

California Coast University
University Of Phoenix

Job Titles Held:

Business Development liaison
Provider Network Representative
Contracts Administrator
Provider Services Representative

Degrees

Bachelor of Science : Healthcare administration , Current
Associate of Science : Healthcare Administration , 2014

Business Development liaison Resume Example

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