Denise Capua
Pelham,NH
Summary
Seasoned health services leader with advanced problem-solving skills dedicated to streamlining operations to increase efficiency and promote organizational growth. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
17
17
years of professional experience
Work History
Director, Physician Services & Compensation
Steward Medical Group, Inc.
01.2023 - Current
- Draft complex Agreements, Employment Amendments, and interface with legal on redlined Agreements
- National oversight of provider contracting team
- Responsible for implementation and coordination of physician contracting
- Work with SMG Leadership Team on national strategic initiatives and projects to enhance operations within organization
- Oversee and optimize all administrative systems and processes, including identifying and executing on opportunities for standardization, process improvement, financial optimization, and operational efficiency across enterprise
- Development of new policies and procedures in preparation of project implementation
- Ongoing contract and PARF training for all new SMG Directors and Regional VPs
- Review contract requests for accuracy and to ensure compensation fell within FMV guidelines
- Liaison between physicians, SMG Directors and Steward Legal to answer contract questions and communicate solutions
- Work with HR, Practice Management and Administrative Director to ensure termination letters are delivered.
- Develop termination process and communication about terminated physicians.
- Recoup prorated bonuses and facilitate tail coverage requests for physicians leaving SMG, as appropriate.
- Manage Salesforce to ensure information entered is consistent with policies.
- Develop management reports and tracking for PCPs and Specialists.
- Ongoing work with Network Development team around on-boarding process to ensure timely start dates.
Manager, Physician Services - Contracting
Steward Medical Group, Inc.
05.2021 - 01.2023
- Managed contracting team which oversaw a panel of 2,000+ physicians and advanced practitioners
- Drafted all provider employment agreements and per diem employment agreements across Massachusetts, Ohio, Pennsylvania, Florida, Texas, Louisiana, Arkansas, Arizona, and Utah
- Processed all contractual amendments and worked closely with provider onboarding and TRACO teams to outline changes related to provider FTE status, malpractice coverage limits, compensation adjustments, accruals, and administrative roles
- Handled provider terminations, including vacation accrual freezes, commencement and signing bonus repayments and invoicing, and communication with Hospital(s) MSO
- Tracked and executed new hire memos for upcoming start dates of providers
- Responsible for all reporting on outstanding contracts pending providers' signatures, outside activities, and future compensation changes
- Managed a team of 3.
Director, Provider Relations and Credentialing
Dane Street, LLC
12.2018 - 02.2021
- National provider of IME, peer and utilization reviews catering to the insurance industry
- Responsible for physician panel oversight of 16,000+ providers while managing a team of up to 8 individuals
- Oversaw the maintenance of new provider profiles as well as the biannual recertification of provider panel
- Ensured accuracy of records related to physician licensure, board certification, National Practitioner Data Bank queries, hospital affiliations and more
- Responsible for adherence to all 300+ client contracts as they relate to physician experience and credentials
- Correspond with national medical director on all malpractice settlements, judgments, license sanctions and/or other issues related to provider panel
- Renegotiate provider pricing to align with business ventures and needs
- Successfully led the team which re-credentialed a backlog of 5,000+ physician profiles
- Assist with company RFP process as it relates to provider panel, credentialing, sanctions reporting and specialty coverage
- Navigated and corrected physician deficiencies as they related to peer-to-peer success rates, jurisdictional sign-offs, inadequate rationale, billable time, contract rates, and more.
Senior National Physician Recruiter
Dane Street, LLC
03.2015 - 12.2018
- Responsible for building national provider network across all insurance lines of business (short/long term disability, worker's compensation, auto and utilization review sectors.) Recruited 3,900 physicians to join Dane Street's panel
- 1,500 of which met preferred pricing and standards (38.5%) against a company metric of 20%
- Negotiated and renegotiated provider pricing to drive revenue and open door for future business ventures
- Successfully reduced provider cost in New England region from 86% to 58% within first 3 months
- Built block time provider networks in New England and New York to aid in referral growth while meeting pricing requirements of aggressive client contract rates
- Led and successfully solved greatest number of open service requests in history of company.
Account Manager
Summit Investigations
09.2013 - 03.2015
- SIU company tailored to providing surveillance services to insurance sector
- Established and maintained relationships with insurance carriers, third party administrators, self-insured entities and municipalities in need of surveillance services
- Responsible for tracking SIU bid openings and deadlines for all proposal requests
- Responsible for creation of company presentations to present to potential clients
- Worked closely with internal and external staff to ensure scope of surveillance was maintained with that of client request
- Responsible for representation of client at all association meetings.
Account Manager
Certified Medical Experts of America
08.2012 - 08.2013
- Provider of IME and peer review services
- Responsible for maintaining and building client network throughout New England
- Created and presented in meetings offering services to prospect companies and individuals
- Brought marketing ideas to the table to drive revenue
- Created CEU course on behalf of company, approved by the state of NH, outlining medical fraud related to insurance claims
- Conversed with clients regarding active claims and ensured compliance with turnaround times related to upcoming litigation, when applicable.
Office Manager
VC&C Cleaners
12.2006 - 08.2012
- Restoration dry-cleaner of textiles and soft goods following fire, smoke and water damage claims
- Managed daily operations and maintenance of records and supplies
- Provided exceptional customer support to clients and Insured
- Contacted insurance carriers to verify correct policy information and obtain authorization for work
- Responsible for keeping in contact with carrier as claim progressed
- Prepared scope of loss details and estimates for reserve purposes for carrier review and approval
- Oversaw fleet of loss coordinators throughout New England
- Scheduled on-site visits to meet with adjusters to review scope of damages
- Oversaw $1m+ in accounts receivables as well as all accounts payable.
Education
Associates - Criminal Justice
University of Phoenix
Phoenix, AZ12.2010
Skills
- Team building and staff development
- Customer service
- Provider negotiations
- Detail oriented
- Leadership and Mentoring
- Project Management
- Network Development
- Attention to detail
- ABMS
- Medical Specialties/sub-specialties
- NPDB/CAQH
- Salesforce
- Fair Market Value
- Microsoft Suite
Awards
Nomination into the National Society of Leadership and Success, 02/2020, 02/2021, University of Phoenix
Timeline
Director, Physician Services & Compensation
Steward Medical Group, Inc.
01.2023 - Current
Manager, Physician Services - Contracting
Steward Medical Group, Inc.
05.2021 - 01.2023
Director, Provider Relations and Credentialing
Dane Street, LLC
12.2018 - 02.2021
Senior National Physician Recruiter
Dane Street, LLC
03.2015 - 12.2018
Account Manager
Summit Investigations
09.2013 - 03.2015
Account Manager
Certified Medical Experts of America
08.2012 - 08.2013
Office Manager
VC&C Cleaners
12.2006 - 08.2012
Associates - Criminal Justice
University of Phoenix
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