Senior Consultant, Project Manager Resume Example Glenridge Healthcare Solutions, Inc

SENIOR CONSULTANT, PROJECT MANAGER

Core Qualifications

Accomplished senior healthcare executive with over 25 years of healthcare experience and knowledge working for both providers and major national insurance payers.
Well versed in project management, network development and provider contracting.
Experienced in data management in existing systems and building data management functions.
Experienced team manager taking large cross-functional teams and bringing them to consensus on difficult projects.
Skilled in financial analysis, strategic planning, rate negotiation, revenue enhancement, forecasting and budget preparation.

Accomplishments

Claims review and analysis for outstanding A/R issues

Experience

Senior Consultant, Project Manager09/2012 － CurrentGlenridge Healthcare Solutions, IncColumbia, MD

Project manager for a large, multi-layered network development project for Medicare Advantage.
Responsible for a team of leads and recruiters executing deliverables to the client to meet CMS guidelines for network approval in pre-determined markets.
Established project protocols and guidelines based on the clients determined needs.
Execute and deliver Medicare Advantage, market ready network to client in established time frames.

Regional Vice President, Payer Relations08/2007 － 07/2012Physiotherapy Associates, IncNashville, Tennessee

Responsible for negotiation of new and existing contracts with Payers, networks and managed care organizations in eight states including contract language evaluation and negotiation.
Operations support for 170 Clinics and one centralized central billing office
Claims review and analysis for outstanding A/R issues
Complex financial analysis to assess impact of reimbursement models

Administrator, Network IPA Operations09/2006 － 08/2007Health Spring of TennesseeNashville, Tennessee

Lead role in physician contracting, involvement in rate negotiations, follow up process
Key responsibility for oversight of IPA network performance including development of monthly action plans
Involvement in pro-forma budget preparation and implementation
Management of provider relations representatives

National Director of Managed Care01/2005 － 05/2006Renal Care Group, IncNashville, Tennessee

Responsible for negotiating local, regional and national payer agreements
Budget preparation and price increase forecasting for assigned markets
Rate Performa preparation and analytic review of revenue impact for contract proposals
Claims review and analysis for outstanding A/R issues *Company acquired by Fresenius Medical Care - position eliminated due to acquisition.

Manager, Provider Relations10/2000 － 12/2004BlueCross BlueShield of Tennessee, IncNashville, Tennessee

Network development responsibility for physician, ancillary and hospital networks
Management and staff development responsibilities for a large regional staff.
Extensive project management experience through development, execution and implementation of assigned initiatives.
Experience in data management, design and development of tracking databases.

Senior Provider Relations Representative08/1999 － 10/2000United Healthcare, IncChicago Nashville, Illinois Tennessee

Responsible for Provider Relations, Credentialing, Compliance & EDI in the Chicago market for a network of 16,000 providers.
Managed multi-level staff including management, professional and bargaining unit staff.
Redesigned and implemented credentialing process supporting provider networks for the health plan.
Developed network management compliance program for managed Medicare programs.
Implemented new educational program for network providers ensuring full compliance with contractual obligations.
Managed a team of ten provider relations representatives.
Organized Medicare+Choice compliance initiative for network management department statewide.
Developed tracking databases to ensure timely credentialing and contracting of providers.
Participated in the Medical Expense initiative to lower the cost of healthcare expenditures for the company.
Responsible for credentialing and contracting network providers for assigned territories
Coordinated large educational programs with key employer groups, including Nissan and Saturn
Educational responsibility for providers to ensure contractual compliance
Served as the liaison to the Medicare+Choice compliance committee

Marketing Representative09/1996 － 06/1997Horizon Mental Health at TCMCMadison, Tennessee

Developed strategic marketing plan for geriatric and medical psychiatric inpatient units
Marketed to and developed referral relationships with key physicians
Organized exhibit participation in trade show and professional organizations
Developed new reporting system to measure productivity and marketing effectiveness

Director of Marketing02/1996 － 09/1996American Day Treatment CentersFairfax, Virginia

Responsible for strategic marketing and referral development with local physicians, hospitals and community based programs.
Developed reporting mechanism for effectiveness of marketing activities
Community Liaison for community mental health and professional organizations *Company went out of business - left to go back to Tennessee to take a position with my former employer.

Behavioral Marketing Associate/Managed Care Specialist01/1995 － 02/1996Tennessee Christian Medical CenterMadison, Tennessee

Responsible for marketing and strategic plan for inpatient and outpatient psychiatric programs.
Developed referral relationships with physicians and community mental health providers
Organized exhibit participation in trade show and professional organizations
Assisted in the development of managed care strategies and data analysis

Ancillary Recruiter / Project Coordinator11/1991 － 01/1995FOCUS Healthcare Management, IncBrentwood, Tennessee

A division of United Healthcare, Inc.) (Multiple Positions)
Supported client needs through electronic data interface
Served as a liaison to clients and assisted with daily transfer of data via electronic media
Oversaw and directed the development of a national Workers' Comp PPO
Supervised a staff of 9 in network management, responsible for credentialing, data managment and execution of PPO contracts with providers.
Negotiated with providers and provided guidance on language/rate requests.
Developed national ancillary PPO network for workers' comp clients
RFP Response Management. Developed and responded to business development requests, serving as the corporate liaison for RFP responses

Marketing/Communications Coordinator10/1990 － 07/1991HCA Southern Hills Medical CenterNashville, Tennessee

Developed marketing programs and materials and worked with physicians to expand community visibility
Responsible for new business development projects & promotions management
Served as the facilities public relations spokesperson responding to media requests for information

Assistant Director, Provider Relations06/1989 － 10/1990Nashville Memorial HospitalMadison, Tennessee

Facility marketing and public relations, newsletters and sales initiatives.
Physician group public relations & program marketing
Community relations liaison

Education

Master of Science:University of St. Francis - Health Services AdministrationJoliet, Illinois, USMay 2004 Master of Science Health Services Administration University of St. Francis Joliet, Illinois

Bachelor of Arts:Eastern Illinois University - JournalismCharleston, Illinois, USMay 1987 Bachelor of Arts Journalism, Speech Communication, and Political Science Eastern Illinois University Charleston, Illinois Community Activities & Memberships: Tennessee Medical Group Managers Association (TNMGMA) Middle Tennessee Healthcare Executives (MTHEA) Madison Kiwanis Club Nashville Kidney Association, Volunteer March of Dimes, Volunteer

The Goddard SchoolParent Advisory Committee, The Goddard School

Certifications

PMP

Professional Affiliations

Tennessee Medical Group Managers Association (TNMGMA)

Skills

Managed Care, Operations, Contracts, A/r, Claims, Medicare, Clients, Databases, Liaison, Billing, Financial Analysis, Marketing, Data Management, Project Management, Business Development, Cms, Content Management System, Leads, Project Manager, Project Coordinator, Recruiter, Rfp, Budget, Budget Preparation, Public Relations, Trade Show, Edi, Mental Health, Healthcare, Recruitment, Forecasting, Increase, Proposals, Strategic Marketing, And Sales, Assistant Director, Community Relations, Sales, Network Operations, Associate, Data Analysis, Marketing Analysis, Outpatient, And Marketing, Geriatric, Marketing Plan, New Business Development, Educational Programs, Access, Database, Database Management, Excel, Leadership Development, Microsoft Excel, Pmp, Strategic Planning, Training

Resume Overview

Companies Worked For:

Glenridge Healthcare Solutions, Inc
Physiotherapy Associates, Inc
Health Spring of Tennessee
Renal Care Group, Inc
BlueCross BlueShield of Tennessee, Inc
United Healthcare, Inc
Horizon Mental Health at TCMC
American Day Treatment Centers
Tennessee Christian Medical Center
FOCUS Healthcare Management, Inc
HCA Southern Hills Medical Center
Nashville Memorial Hospital

School Attended

University of St. Francis
Eastern Illinois University
The Goddard School

Job Titles Held:

Senior Consultant, Project Manager
Regional Vice President, Payer Relations
Administrator, Network IPA Operations
National Director of Managed Care
Manager, Provider Relations
Senior Provider Relations Representative
Marketing Representative
Director of Marketing
Behavioral Marketing Associate/Managed Care Specialist
Ancillary Recruiter / Project Coordinator
Marketing/Communications Coordinator
Assistant Director, Provider Relations

Degrees

Master of Science : University of St. Francis - Health Services Administration
Bachelor of Arts : Eastern Illinois University - Journalism
The Goddard School

Senior Consultant, Project Manager Resume Example

Resume Score: 90%

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