CHRISTINE DOLS
Coon Rapids,MN
Summary
Transformational healthcare business executive with strong contract management skills and cost-effective provider relationships capabilities. Combines a deep understanding of Medicare and Commercial hospital and physician reimbursement methodologies including value-based contracting. Effective in forming positive interactions with both internal and external customers to aid the organization in achieving its organizational goals.
Overview
17
17
years of professional experience
Work History
SENIOR MANAGER, NETWORK CONTRACTING
Aetna, a CVS Health Company (First Health Network)
01.2023 - Current
- Solely negotiated, executed and implemented over 20 First Health Agreements totaling $12M in client charges within 11 months expanding the First Health Network in MN.
- Successfully renegotiated hospital agreements reducing network costs across the MN market.
- Actively establishing strong relationships with hospitals, providers, and stakeholders, ensuring long-term partnerships and continued participation with First Health.
- Collaborating closely with peers from other departments to drive organizational success jointly as one cohesive unit.
- Actively mentoring junior staff members for skill development and career progression within the organization.
- Responsible for resolving conflicts, addressing grievances, and negotiating satisfactory resolutions of payer-related issues and disputes
PROVIDER CONTRACTING EXECUTIVE
Humana
11.2015 - 01.2023
- Evaluated, negotiated, and executed large complex hospital, physician, ancillary, and value-based contracts in compliance with company templates, reimbursement structures, and other key internal process controls.
- Managed contract performance and supported the development and implementation of all contract relationships within assigned territories in support of business objectives and financial goals.
- Recruit hospitals and providers as needed to attain development of a geographically competitive network to achieve network expansion and network adequacy targets.
- Negotiate and execute advantageous company payment models including payment bundles, Quality Spot Program, and IPOP.
- Established and maintained strong business relationships collaborating cross-functionally to manage provider reimbursement, contractual information, and analytics.
- Successfully created and launched innovative market contracting process to improve efficiency as well as collaborative efforts within region.
- Soley selected to participate in Social Determinants of Health Think Tank payment team, Humana’s Provider Experience Lab, Data Management training tool, and new Corporate Hospital Contractor Executive training.
- Negotiated and secured vital national Managed Service Organization agreement by successfully negotiating and collaborating with internal and external stakeholders, increasing access to quality value-based care
- Served as a SME on all hospital, physician, and ancillary contract language and reimbursement issues.
- Assisted in recruiting, hiring and training of team members.
DIRECTOR OF MANAGED CARE CONTRACTS
Welcov Healthcare
10.2014 - 11.2015
- Leveraged managed care, commercial, and Medicaid contracting expertise increasing payor contract participation by one hundred percent for owned skilled nursing, home health agencies and long-term care facilities in six states.
- Solely responsible for authorizing and implementing deviations from standard contract language and rates.
- Developed and implemented company’s first contract management system increasing negotiating efficiency, productivity, and accuracy.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
PROVIDER RELATIONS SUPERVISOR
PreferredOne
11.2007 - 10.2014
- Deployed unique leadership style for six individuals that fostered professional development for team members and elevated their aspirations into open, honest, and collaborative discussions
- Responsible for provider assignments, process implementation and oversight, provider appeals, and Attorney General Complaints
- Served as a liaison between healthcare providers and internal departments such as claims processing or customer service, facilitating effective resolution of any issues that arose during day-to-day operations.
- Improved provider satisfaction through the development and implementation of targeted training programs for staff on provider policies and procedures.
PROVIDER CONTRACT MANAGER
PreferredOne
07.2007 - 10.2014
- Sole Contract Manager for all complex ancillary and specialty providers including but not limited to: DME, SNF, home health, dental, retail pharmacy
- Successfully led and managed network filing for MN Health Care Exchange
- Developed strong relationships with clients and vendors, fostering mutually beneficial partnerships.
Education
Skills
- Network Development
- Contract Management
- Relationship Management
- Data-driven decision-making
- Troubleshooting and problem resolution
- Negotiation
- Customer Relations
- Time management abilities
- Organizational improvement
Timeline
SENIOR MANAGER, NETWORK CONTRACTING
Aetna, a CVS Health Company (First Health Network)
01.2023 - Current
PROVIDER CONTRACTING EXECUTIVE
Humana
11.2015 - 01.2023
DIRECTOR OF MANAGED CARE CONTRACTS
Welcov Healthcare
10.2014 - 11.2015
PROVIDER RELATIONS SUPERVISOR
PreferredOne
11.2007 - 10.2014
PROVIDER CONTRACT MANAGER
PreferredOne
07.2007 - 10.2014
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