Brandy Pruett
Cottonwood Heights
Summary
Leadership, Business Development & Network Program Management with in-depth experience in project management, market research, analysis and evaluating growth strategies. Adept at networking with decision makers, conducting business introductions, growing and developing existing and new provider groups. Excellent with relationship building, communication, leadership and presentation skills.
Overview
17
17
years of professional experience
Work History
Provider Contract Manager
Molina Healthcare
04.2023 - Current
- In collaboration with Director/Manager, Provider Contracts, negotiates Complex Provider contracts involving but not limited to high priority physician group and facility contracts using rate negotiation guidelines.
- Mitigates business risks by analyzing contracts' potential impacts and avoiding unfavorable terms by working with finance team to model out total impact on provider and health plan proposals.
- Develops and maintains provider contracts in contract management software.
- Targets and recruits additional providers to reduce member access to care and overall network adequacy.
- Manages and works through projects surrounding network adequacy guidelines in compliance with CMS standards for Medicaid/Marketplace LOBs.
- Engages targeted contracted providers in renegotiation of rates and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region.
- Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
- Maintains contractual relationships with significant/highly visible providers and all network providers assigned to their territory.
- Tracks contracts for management and issues regular tracking reports covering current status and upcoming milestones.
- Interprets contact terms and coordinated solutions to resolve disputes between clients and service providers.
- Works and collaborates with cross functional teams to ensure contracts are configured and loaded correctly into our claims payment system as well as resolve any provider issues as it relates to their contract.
- Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
- Trains other Contracting staff on contracting processes.
Hospital Liaison
Avalon Health Care/Sandstone Healthcare
09.2022 - 04.2023
- Developed and cultivated lucrative relationships with both new and existing clients through effective communication and exemplary interpersonal skills.
- Devised marketing plans using digital strategies, print advertising, and word of mouth tactics.
- Boosted brand awareness and generated leads while managing internal and external marketing campaigns and programs.
- Created innovative strategies to drive customer engagement.
- Drafted and reviewed all admission contracts. Reviewed with patients and their families.
- Led various departments within the facility to ensure a efficient, high level customer service satisfaction outcome.
- Monitored customer feedback and generated reports to identify areas of improvement.
Provider Network Program Manager
Steward Health Care Network
10.2020 - 06.2022
- Monitor, evaluate and routinely report on the performance of risk provider groups, hospitals, networks and other providers against goals and targets. Identify performance issues and opportunities and recommend strategies to address. Establish best practices necessary to improve HEDIS, CAHPS, and risk adjustment accuracy.
- Engage providers, share specific data points and document obstacles.
- Present obstacles / needs to the local team and work to address collaboratively then report out to the leadership team on status and if further support is needed.
- Review and report out trended performance making sure improvement is being made.
- Collaborate with clinical, quality, and risk adjustment leaders to develop strategies and actions to improve provider group/ network performance as needed.
- Advise market leadership and Regional Network Director of providers who are at risk of leaving the network and develop plans to retain high performing provider groups.
- Serve as the provider relations manager maintaining and retaining the network composition within a Chapter.
- Facilitate Chapter, POD and Board of Directors meetings within my respective.
Regional Director Business Development
Avalon Health Care
01.2020 - 10.2020
- In collaboration with the VP of Marketing, RVP and care center Administrator, create and implement a business development plan for each care center.
- Analyze each care center’s market opportunities and produce measurable growth in census market share for each care center in the region.
- On a monthly basis, provide the VP of Marketing, RVP and Administrators with an external party’s business development visitation matrix and calendar review which defines the business purpose and ROI of each activity and define a clean link to the business development and marketing plan.
- Conduct monthly Business Development meetings with each Administrator, Director of Community Relations and Admissions Coordinator to review census development and upcoming activities for the care center.
• Conduct monthly Regional Business Development meeting with the RVP to review census development progress and to develop plans and strategies for the upcoming quarter to maintain or exceed budgeted census. - Develop and implement a plan to expand the Region’s referral base through enhancing the alliance of service providers.
- Evaluate niche marketing opportunities based on discussion with alliances and competitor analysis.
- Routinely complete a competitor analysis to understand market trends, new entrants, etc.
- Complete and/or coordinate the development of rigorous market analysis of the demographics and market opportunities for each care center.
- Facilitate the use of strategic marketing messages, community education, and alliance development to drive business outcomes.
Provider Network Program Manager
OptumCare-UnitedHealth Group
03.2018 - 01.2020
- Educate providers to ensure that they have the tools they need to meet HEDIS quality measures, and RAF risk adjustment, growth (as appropriate), and total medical cost goals per business development plans facilitated through strategic meetings
- Ensure providers have in-depth understanding of OptumCare model to include, but not limited to, patient care best practices, contractual obligations and program incentives
- Conduct detailed analysis of various reports by tracking data to develop a strategic plan to ensure performance goals are achieved.
- Ensure the overall strategic plan incorporates interventions with internal departments including Medical Directors, Clinical Educators/Coders, Quality/HEDIS nurses, pharmacists and others as needed.
- Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs and/or Specialists.
- Conduct new provider orientations and ongoing education to providers and their staffs on OptumCare programs, processes and compensation arrangements.
- Maintain open communication with providers to include issue resolution on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment program.
- Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans.
- Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed.
- Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates.
- Represented OptumCare by coordinating company sponsored provider events (summits, learning sessions).
- Regularly meet with cross-functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals.
- Introduce and advocate company resources to facilitate practice optimization.
Network Contractor
UnitedHealth Group
04.2017 - 03.2018
- Built a network of healthcare professionals by contracting new providers and maintaining relationships with current providers and community partners
- Draft new contracts and create amendments to existing contracts
- Communicated with clients to review contracts, answer any questions and learn about their unique scenarios and how to troubleshoot
- Developed team communications and information for Network Contact meetings
- Created and improved internal naming conventions of resources to facilitate consistency
- Participated in requirements meetings and data mapping sessions to understand business needs
Director of Admissions
Sandy Health & Rehab
05.2015 - 04.2017
- Maintained admission guidelines by updating and writing new facility policies and procedures
- Drafted facility contracts
- Market programs and facilities by preparing and disseminating informational brochures, social media advertisements, and conducting tours
- Led Admissions team which oversaw all patients entering facility and developed relationships with hospitals, other nursing facilities, hospice agencies, and assisted living facilities to ensure all patients receive best care possible
- Coordinated physical, social, emotional, and transportation services for patients, and ensured facility environment was safe and supportive
- Resolved conflicts and negotiated agreements between parties in order to reach win-win solutions to disagreements and clarify misunderstandings
Supervisor Patient Advocate Program
Myriad Genetic Laboratories
06.2012 - 05.2015
- Created goals, objectives, and recommendations to increase efficiency in the department by using qualitative and quantitative metrics
- Supervised team operations and enforced company policies and procedures
- Led weekly personnel meetings, employee performance evaluations, and coached staff as needed
- Designed process work flows
Self Pay Representative
Sutter Physician Services
01.2012 - 06.2012
- Called patients with outstanding medical bills and assisted insurance claim processing to enable timely filing
- Assisted Sutter's Charity Foundation to help patients in need of financial assistance ABEO - Anesthesia Medical Billing
Medical Billing Specialist
ABEO
06.2008 - 12.2011
- Worked with clients and insurance companies to secure appropriate reimbursement
- Filed appeals on claim denials and underpayments, recommended account write-offs, and adjusted requests
Customer Service Representative
Regence Blue Cross Blue Shield
01.2008 - 06.2008
- Provided excellent customer services by responding to all inquiries regarding coverage, billing, claims, and products in a timely and client-focused manner
- Answered inbound and outbound calls from providers, members, and other medical entities
Education
Licensed Certified Nursing Assistant - Certified Nursing Assistant
CCNA
Murray, UT09.2023
Certification CPR - CPR
CCNA
Murray, UT09.2023
GED -
Salt Lake Community College
Taylorsville, UT2005
Skills
- CMS Guideline knowledge
- Medicare/Medicaid Advantage plan product knowledge
- AEP/SEP Experience
- Marketing/Sales
- Risk Adjustment /HEDIS Quality
- Program Implementation
- Program Development
- Project Management
- Relationship Building
- Leadership
- Network Analytics
- Teamwork/Collaboration
- Staff Development
- Microsoft Office, Google Suite
- Customer Service
- Medical Billing
- Compassionate Caregiver
- Patient Relationship-Building
- Mobility Assistance Needs Understanding
Timeline
Provider Contract Manager
Molina Healthcare
04.2023 - Current
Hospital Liaison
Avalon Health Care/Sandstone Healthcare
09.2022 - 04.2023
Provider Network Program Manager
Steward Health Care Network
10.2020 - 06.2022
Regional Director Business Development
Avalon Health Care
01.2020 - 10.2020
Provider Network Program Manager
OptumCare-UnitedHealth Group
03.2018 - 01.2020
Network Contractor
UnitedHealth Group
04.2017 - 03.2018
Director of Admissions
Sandy Health & Rehab
05.2015 - 04.2017
Supervisor Patient Advocate Program
Myriad Genetic Laboratories
06.2012 - 05.2015
Self Pay Representative
Sutter Physician Services
01.2012 - 06.2012
Medical Billing Specialist
ABEO
06.2008 - 12.2011
Customer Service Representative
Regence Blue Cross Blue Shield
01.2008 - 06.2008
Licensed Certified Nursing Assistant - Certified Nursing Assistant
CCNA
Certification CPR - CPR
CCNA
GED -
Salt Lake Community College
Similar Profiles
Melina GarciaMelina Garcia
Customer Experienced Representative Tier 2 at Molina HealthcareCustomer Experienced Representative Tier 2 at Molina Healthcare
Eartha Green CoxEartha Green Cox
Nurse Practitioner Manager at Molina HealthcareNurse Practitioner Manager at Molina Healthcare
Victor CallesVictor Calles
Health Educator at Molina HealthcareHealth Educator at Molina Healthcare