Program Manager/Vendor Management
Health Insurance Manager, who directs and drives new business, cultivates client loyalty, and delivers revenue through physician, provider and vendor networks. Deep expertise in provider relations and building the relationships that create a robust network. At ease with operational execution, ensuring compliance with contracts and an agile ability to find the root cause of atypical performance before it negatively affects revenue.
Key Skills & Competencies
• Vendor Management • Compliance Manager • Performance Analysis • Physician Contracting • Operational Processes • Account Management • Delegation Oversight • Program Management • Project Management
Healthcare Program Vendor Manager, Aetna (National Provider Network)| Hartford, CT 3 years
Directed and built strong provider relationships with pre-certification vendor contracts worth $20M+. Managed all initiatives and relationships that drove cost savings and expected performance outcomes.
Led program development and rollout for new cost savings programs. Examples:
Steered expansion of chiropractic programs in upstate New York, meeting cost savings and expanding offerings in territory.
Managed pilot vendor high-dollar negotiation process, in collaboration with regional network, to markedly reduce high dollar claims.
As the relationship manager, regularly met and consulted with external vendors to ensure cost savings goals were on target and to provide any operational needs for smooth execution.
Reviewed performance data for anomalies and resolved issues with vendor set-up as operational liaison.
Served as Operations head for the National Provider Network vendor teams.
Managed the data workflow of files and precertifications with the carrier. Worked with IT to resolve issues around data mapping and data integrity.
Delivered estimated 10% savings by optimizing internal processes to improve service delivery by merging specific projects earlier in the process.
Defined and implemented workflows to roll out new focused claim audits program to increase savings.
Initiated partnerships with external vendors for physical therapy, chiropractic and radiology pre-certification vendors to achieve cost efficiencies for the organization.
Created and managed project plans for the implementation process of new savings program rollouts.
Held weekly meetings to ensure vendors met cost savings targets set by organization.
Provider Network Manager, Aetna (Local CT & RI Physicians Network)| Hartford, CT 4 years
Directed a team of contract network negotiators.
Managed the external relationship with physicians and providers.
Directed contract negotiations for individual and group of providers.
Successfully led various teams to develop strategies, workflows, processes and savings opportunities to implement the prepay audit program with external vendors.
Increased the provider network based on plan sponsor needs with the Rhode Island sales team. Worked employee benefit fairs, educating employees about Aetna’s presence in Rhode Island.
Contract Negotiator, Aetna | Hartford, CT 2 years
Negotiated provider contracts to support cost savings for Aetna. Served as liaison for external healthcare providers in Connecticut and Rhode Island.
Successfully built strong trusting relationships with assigned community physicians and IPA/PHOs including CT Children’s Faculty Plan, St. Francis PHO, Eastern CT Health Network and Hartford PHO
Strategically led provider relations functions including contract negotiation and problem solving.
Built strong relationships with external providers. Researched and resolved provider issues for physicians.
Managed and led the provider performance network reconsideration process for the CT Market.
Earned 100% quality indicator score under NCQA requirements.
Received Silver Award for managing all aspects of the ongoing NCQA compliance process at Aetna.
6th Degree Black Belt Instructor in Taekwondo - CT Chung Do Kwan Academy 15+ years
Train students of all ages and ranks in Taekwondo. Build relationships with students and parents, to empower confidence and self-protection. Train students with a focus on fun, and how to be leaders in the Taekwondo school. Organize and manage tournaments, seminars, and community demonstrations.
MS, Executive Health Administration, University of New Hampshire, Durham, NH
BS, Health Management & Policy, University of New Hampshire, Durham, NH