Charmaine S. Everett
Aberdeen,MD
Summary
Dedicated Senior Manager with over 25 years of exceptional management performance.
Offering strong administrative and cross-functional collaboration skills to provide teams with support and guidance to surpass expectations.
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Broad base of professional skills include:
- Vendor Building Relationships, Provider Relations, Project Management, Managed Care, Implementation of Training Programs, Health Care Law, Risk Management, Medical Office Management, Third Party Reimbursement, Business Development, Multiple Site Management, Customer Service Management, Practice Accounting, Project Management, Records Management, Compliance.
Participated in URAC Preparedness Accreditation Leadership team member for JCAHO preparedness .
Overview
47
47
years of professional experience
Work History
Sr. Manager, Provider Relations
National Imaging Associates (Evolent)
10.2008 - Current
- Fostered strong, positive relationships with Health Plan network providers by coordinating, facilitating, educating and outreach via onsite, telephonic and webinar sessions to ensure highest level of satisfaction.
- Direct, coordinate, respond and facilitate problem-solving with other internal operations and client provider relations department to achieve fair resolution and client appreciation.
- Supervise provider relations team providing oversight of 62 Health Plan partners/markets to include communication and education processes.
- Plan, coordinate and execute pre-certification staff training curriculum to ensure staff are certified to provide training to network providers for all products managed.
- Vendor Relations management for 15 Health Plan markets to include 22 lines of business.
- Expanded cross-functional organizational capacity by collaborating with account management , operations, quality, and other internal stakeholders through internal meetings and needs analysis to develop and implement proactive provider relations strategies.
- Facilitate immediate resolution of red-flag provider issues that are client, community, legal or contractual threats with internal personnel as needed.
- Routinely monitor provider performance to target and and perform remedial training sessions based upon area of need.
- Conduct performance evaluations, compensations and hiring to maintain appropriate staffing requirements
Supervisor, Provider Relations
Coventry Health Care Of Delaware
11.2004 - 10.2008
- Applied strong leadership talents, management of day to day activities, implementation of training needs, development, and problem-solving skills to maintain team efficiency and organize workflows for provider relations department.
- Assisted with recruitment and credentialing of new providers, maintained accurate and current provider database
- Resolved fee schedule, contracting, claims payment concerns.
- Developed strategic relationship with Delaware Medical Group Management Association and other societies.
- Ensured compliance with Federal and State regulatory requirements.
- Developed and maintained relationships with hospitals, ancillary providers and other participating network providers in th State of Delaware and Maryland.
Supervisor, Customer Service Call Center
Coventry Health Care Of DE
09.2000 - 11.2004
- Responsible for supervision of day to day activities of customer service department to include 21 staff members
- Oversaw employee performance to foster accurate prioritization and achievement of customer expectations and productivity goals.
- Managed customer expectations, lead team meetings, supervised quality assurance, analyzed complaint reports, and managed execution of team processes and team functions.
- Managed staff development and work standards; provided structured coaching and counseling, analyzed daily, weekly, monthly statistical reports and made recommendations regarding call volume and staff schedules.
- Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
- Foster collaborative relationships with internal and external customers
- Received 3 Corporate Company sponsored honors and awards: Leading by Example Award (Sponsor Sales and Marketing Team, Coventry Health Care), Customer Service Superior Achievement Award 2001 and 2002.
Practice Manager
St Francis Hospital
02.1995 - 08.2000
- Directed and managed daily physician practice operations, staff (clinical and non-clinical), financial management, patient care and support activities at 4 locations.
- Assisted Director with policies, protocols, and performance improvement strategy implementations.
- Pursued new business to support individual and group physician practice growth and expansion.
- Maintained physician's legal, insurance licenses and personal files to ensure compliance with regulatory guidelines
- Coordinated candidate interviewing, selection, and training of new employees.
- Provided outstanding support to entire staff which helped improve process flow and boosted efficiency.
- Provided supervision and management to team of support personnel and management of physicians productivity.
- Received Company sponsored award : Achievers Award in Business and Industry (for customer service- community award)
- Provided supervision and management to team of support personnel.
Office Manager
Robert M. Jones, M.D.
03.1985 - 02.1995
- Recruited, interviewed, supervised, and trained medical and non-medical staff.
- Developed job descriptions and employee policies/procedure manual.
- Coached new hires on company processes while managing employees to achieve maximum production.
- Established workflow processes, monitored daily productivity and implemented modifications to improve overall performance of personnel.
- Handled bi-weekly payroll and insurance billing.
- Scheduled patient appointments for office visits, hospital procedures and admissions.
- Assisted physician with examinations and procedures
- Developed policies and office procedures to ensure compliance with regulatory, State, Federal, health insurance, chart reviews, risk management reviews.
Communication Specialist
Delaware National Guard
09.1977 - 10.1980
- Honorable Discharge
Education
Some College (No Degree) - Business Management
Eastern University
Wayne, PAOrganizational Management
Delaware Technical And Community College
Newark, DE1985
Skills
- Personnel training and development
- Health Plan Provider Relations, Customer Service and Vendor management
- Physician Practice Management
- Adherence to high customer service standards and compliance
- Quality Management
- Process Improvement
- Excellent time management skills
- Effective problem solver
- Inter-department collaboration
Timeline
Sr. Manager, Provider Relations
National Imaging Associates (Evolent)
10.2008 - Current
Supervisor, Provider Relations
Coventry Health Care Of Delaware
11.2004 - 10.2008
Supervisor, Customer Service Call Center
Coventry Health Care Of DE
09.2000 - 11.2004
Practice Manager
St Francis Hospital
02.1995 - 08.2000
Office Manager
Robert M. Jones, M.D.
03.1985 - 02.1995
Communication Specialist
Delaware National Guard
09.1977 - 10.1980
Some College (No Degree) - Business Management
Eastern University
Organizational Management
Delaware Technical And Community College
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