Audrey French

Provides direction and oversight to regulations/accreditation compliance including but not limited to: NCQA, URAC, State and Federal agencies (CMS) for hospital/system.
Strategic Planning and Execution evident through;

• Developing policies and procedures to ensure alignment and compliance with new regulations
• Creating and improving workflows to operationalize policies and procedures driven by State and Federal regulations
• Overseeing new initiatives driven by system integration

Supported Corporate Level leadership by providing guidance, resources, and expertise in terms of management, structure and strategy for development and expansion. Exercised knowledge and understanding of the healthcare industry and offered innovative and forward-thinking solutions to barriers encountered by a telehealth start-up company. Provided leadership support in managing vendor and payer relationships. Led contracting efforts and oversight for expanding provider network in multiple states.

Coordinated high-impact transformation projects and performance reports to ensure successful implementation of workflows, procedures and project goal accomplishment to consistently achieve the Quadruple Aim goals of improved health outcomes, improved experience of care, improved provider experience and improved per capita cost of care for Mosaic CIN covered individuals

• Serve as a liaison between Network Practice Transformation Team and Primary Market Contacts focusing on payer related issues (claims, enrollment, credentialing, utilization management, membership) and collaborate with payers and providers for a resolution.
• Facilitate Provider On-boarding Process.
• Facilitate and Monitor Delegated Credentialing process and contracts including but not limited to reviewing and redlining delegated credentialing agreements, updating Mosaic CIN Credentialing Policies and Procedures, performing yearly payer audits.
• Developed and maintain an integrated credentialing process with Henry Ford Health System.
• Manage Provider Database in Morrisey, PRM and QuickBase.
• Manage Networks Patient Complaint Policy and Process.
• Support Mosaic CIN Leadership in the preparation and facilitation of Credentialing Committee.
• Facilitate monthly meetings to ensure network participation accuracy and alignment with Mosaic CIN Clinical Integration Program

Networked with potential providers for inclusion in the Meridian's Provider Network for all lines of business. Coordinated the contracting process for all potential providers including prospecting, negotiation, credentialing and orientation. Educated providers on Meridian's provider policies and procedures.

• Led provider prospecting and network expansion across Medicare and Medicaid lines of business, ensuring network adequacy, access standards, and regulatory compliance
• Coordinated the end-to-end provider contracting life-cycle, including prospecting, negotiation, credentialing, and on-boarding, in alignment with CMS and State Medicaid requirements
• Educated providers on Meridian policies, procedures, and quality program expectations, supporting compliance and consistent delivery of care
• Partnered with quality and clinical teams to improve HEDIS performance in assigned territories through provider engagement, education, and performance monitoring
• Delivered high-quality provider support and relationship management, resolving operational issues related to claims, authorizations, and administrative processes
• Supported network capacity planning and development, analyzing provider coverage and access needs to meet Medicare and Medicaid network adequacy standards
• Provided training and mentorship to Provider Network Development Representatives across multiple states, promoting consistency in regulatory and quality practices
• Collaborated cross-functionally to identify and resolve provider issues impacting quality performance, member access, and regulatory compliance

Managed Psychiatric Technician team on a day to day basis, assigning tasks, and mentoring new staff.

• Lead Preceptor for new employees and monitored progression through unit and hospital wide orientation.
• Interviewed and assessed potential new hires Assessed new hire competencies and progression throughout orientation.
• Created and modified work schedules for 90 Inpatient Behavioral Health employees.
• Monitored daily staffing according to unit acuity and census for Adult and Geriatric Behavior Health Units.