Danielle Nieto
Houston
Summary
Experienced healthcare contracting professional with a strong background in provider negotiations, network development, regulatory compliance, and contract lifecycle management. Proven ability to support network adequacy, operational performance, and data integrity across multiple systems. Adept at working cross-functionally with legal, compliance, credentialing, and IT to meet organizational objectives. Recognized for driving contract accuracy, supporting system configuration, and fostering strong provider relationships in alignment with corporate strategies.
Overview
14
14
years of professional experience
Work History
Network Manager
Community Health Choice
Houston
11.2024 - Current
- Negotiated provider contracts across hospital, physician, and ancillary networks, ensuring compliance with CMS and state guidelines.
- Coordinated end-to-end contract lifecycle: LOIs, drafts, amendments, execution, and repository management.
- Partnered with legal, credentialing, and compliance teams to align contracts with regulatory and internal requirements.
- Supported issue escalation processes and resolved claim-related contract discrepancies in collaboration with internal teams.
- Led projects focused on contract system updates and tracking mechanisms to support performance monitoring.
Contract Specialist
Texas Children’s Health Plan
Houston
01.2023 - 07.2024
- Negotiated and executed standard provider agreements for multiple lines of business, including new product launches.
- Maintained accurate and timely contract data in provider systems and ensured synchronization across platforms.
- Supported provider network growth through outreach and recruitment initiatives focused on network adequacy.
- Utilized contracting platforms to maintain contracts, validate billing codes, and assess reimbursement accuracy.
Executive Administrative Assistant
Retina Consultants of Texas
Houston
06.2022 - 01.2023
- Audited contract terms for accuracy and compliance, reviewed reimbursement models, and recommended updates.
- Collaborated with executives on cross-functional projects, including network development and provider onboarding.
- Supported contract documentation workflows and process improvements across departments.
Appointment Scheduler
Texas Children’s Pediatrics
Houston
05.2017 - 06.2022
- Managed multi-specialty appointment scheduling workflows with high accuracy.
- Worked with IT and operations teams to improve scheduling systems and provider data accuracy.
- Supported provider information validation and maintained documentation per protocol.
Front Office Specialist
Texas Children’s Pediatrics Cy-Fair
Houston
11.2015 - 05.2017
- Verified and updated patient/provider data in EMRs; supported contract-related referral processes.
- Managed insurance data validation and front-end claim coordination support.
Surgery Coordinator
Tenet Healthcare ENT Cypress
Houston
12.2014 - 11.2015
- Scheduled outpatient surgeries and maintained provider schedules; contributed to departmental training.
- Collaborated with clinical and administrative teams to improve system documentation and provider accuracy.
Lead Medical Assistant
Pasha Snoring & Sinus
Houston
01.2012 - 01.2014
- Coordinated with care teams to optimize clinic workflows and provider scheduling for efficient reimbursement cycles.
- Participated in daily huddles and operations planning for clinic and specialty care delivery.
Education
Bachelor of Science -
University of Phoenix
09.2021
Skills
- Contract Negotiation & Management
- Network Adequacy & Development
- Data Management & System Accuracy
- Cross-Functional Collaboration
- Software & Tools
- Regulatory Compliance
Timeline
Network Manager
Community Health Choice
11.2024 - Current
Contract Specialist
Texas Children’s Health Plan
01.2023 - 07.2024
Executive Administrative Assistant
Retina Consultants of Texas
06.2022 - 01.2023
Appointment Scheduler
Texas Children’s Pediatrics
05.2017 - 06.2022
Front Office Specialist
Texas Children’s Pediatrics Cy-Fair
11.2015 - 05.2017
Surgery Coordinator
Tenet Healthcare ENT Cypress
12.2014 - 11.2015
Lead Medical Assistant
Pasha Snoring & Sinus
01.2012 - 01.2014
Bachelor of Science -
University of Phoenix
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