Summary
Overview
Work History
Education
Skills
Accomplishments
References
Timeline
Generic

Alexia Demirjian

Frisco,TX

Summary

Strong leader and problem-solver dedicated to streamlining network operations and oversees every facet of production with strong project management and decision-making skills. Brings comprehensive knowledge of Provider Networks Operations/Contracting production writing, planning and technical operations. Offering over 20 years skills coordinating production plans and personnel resources to complete work under tight deadlines. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.

Overview

15
15
years of professional experience

Work History

Director of Provider Network Operations

Health New England
11.2023 - Current
  • Oversaw the Provider Appeals, Provider Credentialing, Provider Data Management and Provider Network Support Dept and provided corrective feedback resulting in increased productivity and streamline.
  • Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
  • Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
  • Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
  • Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
  • Negotiated favorable contracts with vendors for reduced costs and improved service quality.

Sr. Network Development Contract Manager

Senior Whole Health of MA (Molina Healthcare Inc.)
08.2022 - 11.2023
  • Lead the Network Development Team for negotiating agreements with all new providers and provider expansion
  • Provide expert guidance in leading Hospital and Behavioral Health risks contracts potential impact and execution.
  • Coordinated regular contract reviews to identify areas for improvement or renegotiation opportunities.
  • Developed strong relationships with clients and vendors, fostering mutually beneficial partnerships.
  • Achieved successful contract negotiations by thoroughly reviewing and analyzing proposals, agreements, and terms.
  • Onboarded and trained new staff to keep team efficient and prepare team members to effectively handle demands of simultaneous and large-scale contracts.
  • Managed, supervised 5 contract staffs and controlled executions of all new contracts implemented by staffs.
  • Collaborated with cross-functional teams to develop comprehensive contract strategies aligned with company objectives.

Lead Implementation Manager, Network Development

Beacon Health Options (Carelon)
03.2021 - 08.2022
  • Supervised a team of 6 provider contract coordinator for all new provider joining the network for all states
  • Managed multiple simultaneous implementations with minimal supervision, demonstrating strong organizational skills and adaptability.
  • Presented project updates to senior leadership, highlighting successes and addressing challenges with proposed solutions, ensuring ongoing support for implementation team's efforts.
  • Implemented continuous improvement initiatives that resulted in increased efficiency across various stages of implementation process.
  • Oversaw implementation lifecycle processes based on organizational needs, regulatory requirements, and customer demand.
  • Negotiated contract terms with vendors and suppliers to secure favorable pricing for clients while maintaining high-quality service delivery standards.
  • Troubleshot technical issues during implementations, working closely with IT teams to resolve problems quickly and minimize downtime for clients involved in specific scenarios encountered.

Manager Network Operations (Credentialing/Data)

Beacon Health Options
02.2019 - 03.2021
  • Managed Credentialing/Data/ and Provider Relations Dept. and motivated employees to be productive and engaged in work.
  • Successfully managed multiple projects simultaneously by prioritizing tasks according to urgency, resource availability, and alignment with organizational goals.
  • Planned, designed, and scheduled phases for large projects.
  • Established effective communication among team members for enhanced collaboration and successful project completion.
  • Developed comprehensive project plans with clear timelines, milestones, and budget requirements, ensuring timely delivery of high-quality results.
  • Coordinated with cross-functional teams to resolve project issues and mitigate risks.

Project Manager, Network Initiatives

Beacon Health Options
01.2018 - 03.2019
  • Under the direction of the AVP of Network Initiatives, drives new operating models, products and program and process standardization to transform the Network Management Department.
  • Met project deadlines without sacrificing build quality or workplace safety.
  • Coordinated cross-functional teams and resolved conflicts, maintaining a positive work environment throughout the project lifecycle.
  • Provided detailed technical and operational direction in project challenges, consistently meeting deliverables according to deadlines.
  • Negotiated and managed third-party contracts related to project deliverables.
  • Implemented continuous improvement initiatives to optimize project outcomes while maintaining cost-effectiveness.

Implementation Manager, Network Development

Beacon Health Options
12.2017 - 12.2018
  • Under the direction of the AVP of Network Development, coordination of all Network Development Implementation & Select Network Expansion activities.
  • Presented project updates to senior leadership, highlighting successes and addressing challenges with proposed solutions, ensuring ongoing support for the implementation team''s efforts.
  • Led a diverse team of professionals in successfully completing complex implementations on time and within budget constraints.
  • Led technical upgrade projects for clients by working and coordinating with consultants and developers for integrations.
  • Maintained accurate records of project documentation including status reports, meeting minutes, resource tracking spreadsheets which aided future decision-making activities efficiently when required often.
  • Developed comprehensive training materials for new Implementation Managers, improving onboarding efficiency and team cohesion.

Manager of Network Development & Contracting

Beacon Health Strategies
03.2014 - 12.2017
  • Managing 5 Health Plans in the Texas market for all recruitments of provider/group/hospital, assist in other Market as needed
  • Built high- performing teams through effective recruitment, onboarding 7 Contract Specialist.
  • Participated in the process of improvement for delegated agreements and Single Case Agreements.
  • Onboarded new employees with training and new hire documentation.
  • Streamlined workflows by identifying bottlenecks in existing systems and proactively addressing these challenges through appropriate solutions implementation.
  • Improved network efficiency by developing and implementing strategic plans for infrastructure upgrades and expansions.
  • Continuously improved internal processes by gathering feedback from team members, analyzing performance metrics, and making necessary adjustments.

Sr. Provider Network Manager

Coventry Healthcare/Aetna
10.2011 - 03.2014
  • Managed and implemented process flow for the National Network - for Workers' Compensation LOB roll out + ongoing projects for Data Quality Initiatives, ensuring successful client satisfactory, while maintaining compliance with all contracting scope and cost specifications within the company for HMO/PPO Products.
  • Coordinated with legal counsel to draft new contracts or revise existing agreements as needed based on changing business requirements or regulatory updates.
  • Managed a team of contracting professionals, ensuring adherence to company policies and procedures.
  • Established clear performance metrics for contracted partners, ensuring timely delivery of services in accordance with agreed-upon standards.

Revenue Control Analyst - Claims Dept.

Lahey Healthcare Inc.
10.2009 - 03.2011
  • Established, maintained and improved base of financial controls, building, documenting and executing repeatable accounting processes.
  • Investigated instances of non-compliance or anomalies, promptly addressing any identified concerns to protect company assets.
  • Built strong relationships with external auditors, cooperating fully during audit engagements to support transparency and trust.
  • Strengthened internal controls by developing comprehensive policies and procedures.

Education

AS Behavioral Science Program -

Granite State College- UNH
Concord, NH
05.2024

Study Medical Technology - Science -

University of Mass
Lowell
01.2005

High School Diploma -

Lowell High School
Lowell, MA
06.2000

Skills

  • Strategic Planning
  • Operations Management
  • Project Management
  • Organizational Development
  • Contract and Vendor Management
  • Contract Negotiation
  • Legal and Regulatory Compliance
  • Contract Management

Accomplishments

  • Member of the Credentialing Caucus (Coventry Health, Credentialing Caucus Committee 2012-2014)
  • Member of the WCRI (Workers' Compensation Research Institute) 2012 - 2014
  • Certificate Public Communications Achievements (Devry University, Dean List 3.8 GPA, 2008)

References

References are available upon request.

Timeline

Director of Provider Network Operations

Health New England
11.2023 - Current

Sr. Network Development Contract Manager

Senior Whole Health of MA (Molina Healthcare Inc.)
08.2022 - 11.2023

Lead Implementation Manager, Network Development

Beacon Health Options (Carelon)
03.2021 - 08.2022

Manager Network Operations (Credentialing/Data)

Beacon Health Options
02.2019 - 03.2021

Project Manager, Network Initiatives

Beacon Health Options
01.2018 - 03.2019

Implementation Manager, Network Development

Beacon Health Options
12.2017 - 12.2018

Manager of Network Development & Contracting

Beacon Health Strategies
03.2014 - 12.2017

Sr. Provider Network Manager

Coventry Healthcare/Aetna
10.2011 - 03.2014

Revenue Control Analyst - Claims Dept.

Lahey Healthcare Inc.
10.2009 - 03.2011

AS Behavioral Science Program -

Granite State College- UNH

Study Medical Technology - Science -

University of Mass

High School Diploma -

Lowell High School

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Alexia Demirjian