Innovative, customer-oriented healthcare professional with background in managed care, home infusion and specialty pharmacy. Strong background in contract negotiation, claims analysis and management principles and practices. Seeking a leadership role in a growing managed care organization.
Microsoft Office products, Lotus Notes, multiple claims payment platforms and other Windows/DOS based systems.
Payor and Provider Experience
Medicare and Medicaid Knowledge
Director of Contract Management, 07/2014 to Current BioScrip, Inc. – Eden Prairie, MN
Managed a team responsible for ensuring a smooth end to end contracting process, including contract generation and review, credentialing, and execution.
Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
Owner of the contract repository, ensuring all contracts both physical and electronic were properly stored and easily found when necessary.
Responsibility for all Medicare and Medicaid enrollments/re-enrollments.
Developed and executed a home health agency/nursing services contract strategy, lowering the average cost of external nursing services while improving on the overall quality of the nursing network.
National Program Manager, 03/2011 to 06/2014 UnitedHealth Group – Milwaukee, WI
Collaborated with a variety of teams and departments to help develop and enhance the UHC National Drug Code (NDC) pricing system.
Owned NDC fee schedule creation and pricing.
Managed national home infusion and specialty pharmacy provider relationships, which included negotiations, education and service opportunities.
Rolled out multiple system enhancements, as well as a MAC (Maximum Allowable Cost) pricing enhancement to allow for increased drug savings.
Created a Hemophilia Treatment Center contracting strategy, which was implemented across the organization.
Owned the contracting documents for Home Infusion, Specialty Pharmacy and Hemophilia Treatment Centers.
Government Programs Operations Manager, 04/2010 to 03/2011 UnitedHealth Group – Milwaukee, WI
Medicare specific role with the National Ancillary Strategy team.
Involved in the strategy and relationship with our internal partner OptumHealth.
Managed national provider relationships, which included negotiations, education and service opportunities.
Actively participated in multiple system implementations.
Worked closely on hearing aid issues, current strategy and future growth/development opportunities.
Network Contractor, 04/2009 to 04/2010 UnitedHealth Group – Milwaukee, WI
Promotion from the Associate Network Contractor position, adding increased responsibility and higher profile accounts.
Managed the relationship with three tier 1 hospital and provider groups, along with many smaller medical groups.
Involved in two system implementations, and took on the SME role for the UNO (Siebel CRM) system.
Helped to grow and improve on UHC's quality and service initiatives, further fostering a culture of service.
Associate Network Contractor, 07/2007 to 04/2009 UnitedHealth Group – Milwaukee, WI
Negotiated contracts, adding individual physicians and small groups into the UnitedHealthcare Physician Network.
Improved provider and customer relations by educating the providers and solving complex system issues.
Quickly resolved provider issues and facilitated accurate claims payment.
B.S: Business Administration International Business and Finance, May 2007 Marquette University - Milwaukee, WI Business Administration International Business and Finance