Ayman Barbari

· Relationship manager for employed and independent providers and assisted by helping simply practice’s experience with FHHS while working to identify and address improvement opportunities.

· Worked collaboratively with internal PHSO departments including Credentialing, Provider Data Management, Contracting and Network Development.

· Responsible for executing plans and delivering key messages to providers and office staff. Served as a subject expert matter on matters related to credentialing, contracting and payer related issues.

· Provided consultation and education to network providers by establishing and maintaining a strong relationship with the provider and practice.

· Made regular visits to PCP and Specialists providers with the intent to advise and educate on a wide variety of topics (population health strategies and programs, clinical integration, incentive programs, provider portal, and PHSO provider network policies and procedures).

· Responsible for tracking, measuring, analyzing and reporting on provider contacts, updating provider demographics, validating provider contact information and reporting issues in the designated provider reporting tool.

· Facilitated practice change management regarding emerging trends related to AHPN initiatives, reimbursement models, patient satisfaction, customer outreach, panel growth, and provider performance with and efficiency metrics.

Uphold and administer all theater policies.

Train, develop, coach, and supervise non-management employees. Perform all staff positions as required.

Monitor risk management as it pertains to theater, safety, loss prevention, emergency situations, and the proper handling, reporting, and investigating of accidents.
Ensuring guest satisfaction.
Counting, depositing, and reconciling all receipts taken in during a business day.

· Disciplined, energetic employee who quickly establishes rapport with members, providers and colleagues.

· Received inbound telephone inquiries from Disney Cast Members, Florida Hospital Employees and answered inquiries related to enrollment, benefits related to Cigna HMO and Florida Hospital Care Advantage insurance plans.

· Provided guidance and expertise to members of multiple populations, regarding issues related to ED discharge such as follow up appointments, navigating the AHPN and connecting patients to appropriate medical staff.

· Assisted members with ED care complaints by questioning and gathering information related to visit and file report for member regarding their experience.

· Routinely received provider calls regarding invoices, claims, contract questions and would connect provider to Provider Relations Representative for further assistance.

· Assisted providers with questions about joining AHPN and entered interest applications into Maximizer for PHSO Provider Data Management, Credentialing and Provider Relations processing.

· Maintained accurate records of customer interactions and feedback.

Settles the health plan's subrogation (i.e. third-party liability claim) and reimbursement interest.
Negotiates with the service provider, insurance attorney, insured, etc. in pursuit of recovering
payments for services that should have been paid by another party
Applies legal principles and practices of subrogation to maximize recoveries

Analyzes and reviews paid medical claims to ensure the recovery amount is consistent with settled agreement
Applies coordination of benefits (COB) practices to minimize overpayment by client
Perform onsite auditing of healthcare providers' accounting records to identify and recover
overpayments made by client
Reviews and interprets employee benefit plan language or insurance contracts to ensure the plan rights are adhered to
Ensures compliance with federal, state and local legislation regarding reporting and privacy issues

Reviewed resumes, conducted phone screens, and managed candidate pipelines.

Prepare resumes for presentation to clients.
Present job opportunities to qualified candidates.
Coach candidates through the client interview process.
Develop, build, and maintain relationships with candidates and consultants.
Demonstrate excellent sales, negotiation, communication, and problem-solving skills in a fast-paced environment.

Collaborated with hiring managers to understand position requirements.

Maintained Applicant Tracking System records of all applicants.

Successfully managed a dynamic provider territory of 425 healthcare providers while achieving goals of improving provider satisfaction, increasing electronic claim capabilities, and developing business relationships with key providers.
Negotiated high-volume physician and ancillary contracts, as well as served as a liaison for all contractual and service issues for providers.
Provided optimum education and training to providers regarding contract benefits, coverage, contracts, and product guidelines, resulting in familiarity and provider satisfaction as a whole.
Developed and enhanced business relationships through direct contact with all levels of the provider community and leaders to align contracting needs and efforts; routinely conducted face-to-face meetings with providers to address changes in utilization and managed care policies and practices.

High volume phone interaction with insurance carriers, as well as patients, to service and seek resolution of account balances.
Routinely resolved inappropriate or incorrect payments from insurance carriers due to noncompliance with payer contracts or governmental agency rates.
Utilized knowledge of contracts, regulatory, and contractual guidelines to determine the likelihood of an account being paid after an initial rejection from insurance carriers.
Successfully identified trends in payer non-compliance and consistently informed management and/or managed care liaisons if unable to resolve issues with payers.
Prepared and invoiced attorneys for subpoenaed documents.

Answer 100+ inbound calls daily from employees and providers of service.
Quoted benefits, checked claim status, and requested reviews of claims processing errors by the claims department with documentation of all calls in RIMS computer systems.
Knowledgeable of ICD-9 and CPT codes, as well as standard coding techniques for hospital and dental claims.