Deanna Zdinak
Summary
A business professional with experience in Healthcare Management, Business Development with an innate ability to build and maintain relationships. An articulate communicator, skilled in gathering, analyzing, and translating business requirements into sophisticated strategies with the talent to influence key stakeholders while delivering outstanding results and service in competitive markets.
Overview
12
12
years of professional experience
Work History
Provider Engagement Administrator III
PA Health & Wellness
12.2022 - Current
- The Provider Engagement Administrator is the internal and external liaison for the Provider Network
- Management Department who maintains positive working relationships with participating physicians, participating physician groups (PPG's), hospitals, multi-specialty groups, and/or ancillary providers within an assigned area
- Evaluated operational practices and identified improvement opportunities to develop revisions for systems and procedures.
- Responsible for daily administration and operation of the contractual provider relationships including overseeing accurate and current provider databases, providing training, education and information to providers, coordinating regulatory filings and rollouts, and researching, analyzing and resolving complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and language interpretation, appeals, grievances and eligibility.
- Conducted routine facility inspections, identifying areas needing improvement for continued compliance with associated regulations.
- Liaised with providers to develop comprehensive care gap closure plans to ensure the highest quality of care.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Implemented successful healthcare quality programs through professionalism, collaboration and provider training.
Provider Network Specialist II
PA Health & Wellness
07.2018 - 12.2022
- Conduct initial provider orientations as well as ongoing educational outreach
- Educate providers regarding policies and procedures related to referrals, claims submission,credentialing documentation,web site education, Electronic Health Records, Health Information Exchange, and Electronic Data
- Interface
- Enhance account relationships by investigating, documenting and resolving provider matters andeffectively handling and responding to account changes and correspondence
- Engage providers and educate them on Patient Centered Medical Home initiatives
- Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set(HEDIS) analyses, and create reports for provider Review provider performance by both quantitativemetrics and qualitative factors
- Create and communicate milestone documents, dashboards and success or improvement metrics
- Deanna Zdinak - page 1
- Act as a liaison between the provider and the health plan ensuring a coordinated effort in improvingfinancial and quality performance
- Provide information and status updates for providers regarding incentive agreements
- Conduct site visits when required
- Perform other contracting duties as requested, including but not limited to recommending changes topricing subsystems, submitting changes to provider related database information and assisting in thecompletion of special projects
Provider Network Specialist I
PA Health & Wellness
03.2017 - 07.2018
- Perform duties to act as a liaison between providers, the health plan and Corporate
- Perform training,orientation and coaching for performance improvement within the network and assist with claimresolution
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Conduct monthly face-to-face meetings with the provider account representatives documentingdiscussions, issues, attendees, action items, and research claims issues on-site, where possible, androute to the appropriate party for resolution
- Receive and effectively respond to external provider related issues
- Provide education on health plans innovative contracting strategies
- Investigate, resolve and communicate provider claim issues and changes
- Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updatingorientation materials
Regional Director
American Heart Association
08.2014 - 08.2015
- Built, nurtured and developed and partner with C-Level Business Executives, Lawmakers, Healthcareproviders and others to establish significant relationships to generate revenue to fund vital research,community programs and awareness/education
- Managed multiple year-round campaigns and projectssimultaneously, building relationships with corporate sponsors, recruit, train, partner, manage andmotivate volunteers and volunteer leadership to set and achieve aggressive goals
- Key Achievements
- Successfully mastered a very sharp learning curve in a short period of time, to develop and implementmultiple events
- Proactively evaluated competitive activity and operations and determined recommendations torestructure the organization and to improve the organizations territory activity
- Consistently expanding customer base while maintaining excellent client rapport despite intensemarket competition and a tumultuous situation and challenging economic climate
- Established effective business relationships with key contributors in territories, including all the majorhospitals personnel and CEOs to immediately rebuilding multiple struggling territories
Managed Care Project Manager
Cardon Outreach
05.2012 - 07.2014
- Deanna Zdinak - page 2
- Lead daily operations in the Pennsylvania region while managing a Medicaid eligibility projectcollaborating with Revenue Cycle Management at the University of Pittsburgh Medical Center hospitals
- Responsible for hiring, leading and managing a cross-functional team of Patient Advocates, Field
- Rep and Team Lead
- Developed training curriculum, materials and staff resources
- Maintained keyclient relationships; which included PA DPW Executives, Supervisors and Caseworkers
- Ensuredproject compliance and alignment with corporate goals and industry standards
- Prepared and provideddata and generated reporting for Senior Management & Client
- Monitored billing procedures anddocumentation, and provided updates with regulatory compliance; conducted periodic audits; andmaintained files to ensure staff was obtaining adequate information and complying with HIPAA
- Created, developed and improved relationships with Clients, Facilities, Partnering Agencies and
- Business Associates
- Achievements
- Captured $10M+ in certification dollar balances with 300+ approved cases in first six months
- Strategically restructured project process to overcome challenges during mid-implementation
- Developed, negotiated, cultivated and grew two product lines (disability and seconds) due toprogram's initial success for an increase of $1.5 million in annual billing
- Managed and motivated employees utilizing motivation within a matrix system focusing on teamworkand excellence
Education
MBA - Business Administration
University of Phoenix
07.2023
Project Management
University of Phoenix
12.2024
Bachelor's Degree - Organizational Leadership & Professional Communications
Duquesne University
Skills
- Relationship Management
- Training & Education
- Business & Network Development
- Quality & Performance Management
- Project Management
- Process Improvements
- Business Analysis
- Cross functional Collaboration
- Managed Care: Medicare, Medicaid, Marketplace
- Data Analysis
- Provider Relations
- Provider Orientations
- Educational Presentations
- Customer Needs Assessments
- Strategic Business Relationships
- Provider Support
- Claims Reviewing
- Billing Discrepancy
- Account Development and Networking
- On-Site Visits
- Health Plan Operations
- Physician Recruiting
- Benefits Explanations
- HIPAA Guidelines
- Data Collections
- Quality Reporting
- Quality Assurance
- Medical Records Review
- Quality Improvement Plans
Quote
It is never too late to be what you might have been.
George Eliot
Timeline
Provider Engagement Administrator III
PA Health & Wellness
12.2022 - Current
Provider Network Specialist II
PA Health & Wellness
07.2018 - 12.2022
Provider Network Specialist I
PA Health & Wellness
03.2017 - 07.2018
Regional Director
American Heart Association
08.2014 - 08.2015
Managed Care Project Manager
Cardon Outreach
05.2012 - 07.2014
MBA - Business Administration
University of Phoenix
Project Management
University of Phoenix
Bachelor's Degree - Organizational Leadership & Professional Communications
Duquesne University