ERICA RUSSIN
Orefield,USA
Summary
Transformational leader and partner with 26 years in the Healthcare Industry, delivering successful healthcare solutions in Managed Care, Post-Acute Care, and Quality Initiatives.
Performance management professional with a comprehensive background in enhancing team efficiency and implementing effective performance strategies. Known for strong focus on team collaboration and achieving results. Recognized for flexibility in adapting to changing needs and proficiency in leadership and communication skills.
Overview
19
19
years of professional experience
Work History
Network Performance Manager
Helion
12.2021 - 10.2023
- Provide solutions tailored for providers to empower more impactful care to their patients.
- Quarterly on-site and TEAMS scorecard reviews with post-acute entities (Home Health Agencies, Skilled Nursing, LTACH, Rehab Facilities, and Hospitals) to discuss opportunities and performance outcomes and share best practices.
- Analysis of technology and Episodic reimbursement methods.
- Maintain current market knowledge, industry knowledge, and innovation awareness to drive the change needed to transform healthcare delivery and reimbursement. Collect market intelligence to contribute to strategic planning and design of products and networks.
- Review operational practices, develop training strategies, and hold regular performance data sessions across the provider network.
- Providing tools to providers to deliver better outcomes and create higher patient satisfaction.
- Collaboration with large health systems to connect the care continuum from acute inpatient stays to home.
- Market review and in-person analysis of potential contracts into the Highmark network.
- Complex patient placement.
Client Liaison
Helion
03.2019 - 12.2021
- Acts as a point of contact between Helion and its clients (Home Health Agencies, Skilled Nursing, LTACH, Rehab Facilities, and Hospitals).
- Managed and maintained client relationships, met clients' needs and expectations, and resolved issues.
- Complex patient placement.
- Project managing.
- Analyze and present data related to Home health agencies, SNFs, LTACs, and hospitals.
- Distribution of reports.
- Improving transitions of care.
Provider Account Liaison
Highmark Inc.
02.2017 - 03.2019
- Proactively identify provider issues, recommend solutions, and ensure the provider receives the necessary support and resources to carry out the solutions. Coordinate in a matrixed liaison role with operations and support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.
- Lead and manage relationships with assigned providers to proactively measure, anticipate, and prevent issues, continually improve operational efficiencies, and achieve corporate objectives around programs and strategic initiatives with providers.
- Drive the high-level interactions and direction of the Pay for Value (P4V) relationships, VBR, STARS and HEDIS. Communicate with the appropriate business leaders on program participation, opportunity, performance, and progress. Engage appropriate resources, tools, analytics, and reports to enable success in the programs, driving better health outcomes, lower unit costs, and higher patient satisfaction for our members.
- Oversee administration of critical and timely communication to providers through ongoing personal contacts, on-site field visits, regional communication sessions, and meetings with professional organizations to communicate initiatives and changes.
- Collect market intelligence to contribute to strategic planning and design of products and networks.
- Coordinate with internal teams for initiative development and issue resolution.
- Responsible for assessing data and presenting to PCP ROI opportunities across commercial and government businesses.
Manager of Contracting and Credentialing
Drayer Physical Therapy Institute
06.2016 - 02.2017
- Define strategy for Payer contracts, including terms, services rendered, network, and rate schedules across 15 states.
- Responsible for conversion of payer contracts for newly acquired clinics; establishing the contract strategy to align terms with the overall Drayer corporate contract strategy.
- Overseeing critical legal documents relating to projects.
- Creation, negotiation, and contract negotiation.
- Managed team responsible for credentialing activities for healthcare providers servicing more than 148 outpatient clinics.
Medical Device Sales and Claims Reimbursement Manager
TIMM Medical Technologies, Inc
03.2016 - 05.2016
- Created and managed the Claims Reimbursement team responsible for processing patient claims.
- Responsible for maintaining and negotiating new contracts.
- Successfully converted 60% of patients with denied coverage claims to cash sales.
- Identified and implemented a claims management platform to support sales operations.
Provider Relations Representative
Aetna Better Health
08.2010 - 02.2016
- Lead and manage activities to implement the provider network and contracting strategies for the large/complex provider groups.
- Present quarterly at the American Association of HealthCare Administration Management (AAHAM).
- Provide solutions to network providers and their office staff, achieving outcomes that meet/exceed contracted guidelines.
- Perform onsite orientation for newly recruited provider groups and their staff.
Program and Provider Relations Specialist
Liberty Healthcare
10.2006 - 04.2008
- Investigated fraud and abuse referrals from Medicaid Managed Care plans to assess the legitimacy of the complaint and refer valid claims to the Office of the Attorney General’s Medicaid Fraud Control.
- Reviewed updated policies and procedures submitted by Managed Care plans requiring BPI approval before being released to their membership.
- Provided content and language recommendations for contracts with managed care providers.
- On-site monitoring visits with contracted providers to ensure appropriate care guidelines.
- Summarized claim data analysis and supported the production of case summaries.
- Customer: Bureau of Program Integrity (BPI)
Provider Relations Representative
Geisinger Health System
06.2004 - 10.2006
- Liaison between providers and clinical staff at Geisinger Health Plan to bring resolution to claims payment and billing issues promptly.
- Managed healthcare policy changes and provided educational updates to providers and their staff within my territory across all specialties.
- Facilitated resolution of escalating credentialing issues in addition to managing complex projects.
- Business Service Coordinator
Education
Bachelor of Science - Business Administration, Health Care Management and Human Resources
Central Penn College
Summerdale, PA05.2013
Skills
- Managed care coordination
- Healthcare administration
- Healthcare provider relations
- Health insurance management
- Data interpretation
- Strategic team engagement
- Patient care coordination
- Process optimization skills
- Project Management
- Client support
- Client relationship management
- Population Health
- Quality performance evaluation
- Compassionate communication
- Supportive communication
- Coaching and mentoring
- Customer focus
- Performance analysis
- Stakeholder management
Affiliations
Member of the American Association of HealthCare Administration Management NE PA – 2010-Current
ADDITIONAL
- Helion GEM Mentorship Program-2021-23
- Helion-Highmark Core Behavior Recognition-March 2023
- Christmas Presents for Seniors 2019-21
Timeline
Network Performance Manager
Helion
12.2021 - 10.2023
Client Liaison
Helion
03.2019 - 12.2021
Provider Account Liaison
Highmark Inc.
02.2017 - 03.2019
Manager of Contracting and Credentialing
Drayer Physical Therapy Institute
06.2016 - 02.2017
Medical Device Sales and Claims Reimbursement Manager
TIMM Medical Technologies, Inc
03.2016 - 05.2016
Provider Relations Representative
Aetna Better Health
08.2010 - 02.2016
Program and Provider Relations Specialist
Liberty Healthcare
10.2006 - 04.2008
Provider Relations Representative
Geisinger Health System
06.2004 - 10.2006
Bachelor of Science - Business Administration, Health Care Management and Human Resources
Central Penn College
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