FAIRY N. Jolly

• Streamlined therapy referral process to ensure timely connections
• Negotiated one-time rates for each referral to establish fair compensation
• Converted one-time rate contracts into long-term contracts to secure ongoing partnerships
• Analyzed network to identify areas requiring additional provider coverage for improved service delivery
• Scheduling therapy referrals within the Therapy Direct network

• Identified, initiated, negotiated, and finalized national facility and physician contracts to enhance network capabilities.
• Increased in-network access by contracting and managing nationally contracted facilities within Corvel's proprietary networks in assigned jurisdiction.
• Analyzed client needs and strategic market directives, utilizing and interpreting analytical data to inform decision-making.

• Negotiate long-term contracts with individual physicians, physician groups, ancillary providers, IPAs and hospitals
• Analyze PPO network to develop relationships with other key PPO network partners to meet the needs of current and potential clients (i.e. Employers, Payors, TPAs, self-insured, insurance companies)
• Develop strategies for Tennessee client projects to enhance client satisfaction and engagement.
• Managed daily operations, conducted annual reviews, and facilitated interviews for contractor candidates.

• Defined strategic direction for project initiatives and established project parameters for continued development and expansion of national PPO network. Oversee and coordinate all contracting activities analyzing current PPO network for development, based on customization and expansion efforts of staff. • Assign projects to Directors and Supervisors and assign staff to each according to the needs and requirements of the projects being dealt with for a staff of 45+ employees. • Assisted in selection of Prime Health staff by conducting interviews, placing offers, implementing benefits, and monitoring performance through individual analytics to ensure maximum return-on-investment. • Development and implementation of action plans to accomplish goals in strict timeframes and increase company revenue • Development and facilitation of comprehensive training program for staff. • Establish relationships with other key PPO network partners to meet the needs of current and potential clients (i.e.) Employers, Payors, TPAs,Self-insured, insurance companies. • Collaborated with Sales and Marketing to developCollaborated with Sales and Marketing teams to establish and nurture new client relationships, enhancing network growth.CContracting hospital systems and preserving relationships by assisting Claims Dispute Department in resolving difficult dispute situations. • Contributed ideas for development and refinement of proprietary software systems, improving operational efficiency and functionality.• Work with I.T. Department in establishing analytical reports and processes in place to monitor and develop staff performance.
• Directed strategic initiatives to enhance operational efficiency across healthcare services.
• Collaborated with executive teams to align organizational goals and priorities.
• Oversaw budget management to ensure optimal resource allocation for health programs.

*Promotion

Analyze PPO network to develop relationships with other key PPO network partners to meet the needs of current and potential clients (i.e. Employers, Payors, TPAs, self-insured, insurance companies). • Provider Contracts: Negotiate long-term contracts with individual physicians, physician groups, ancillary providers, IPAs and hospitals. Product lines include Workers Compensation, Group Health and Liability. As of 2007, additional product lines to include Medicare and Medicare Advantage, Indigent Population. • PPO Lease Contracts: Negotiate Statewide, Regional and National PPO Network lease arrangements to enhance Prime Health's national PPO coverage. Lease contracts provided access to the PPO partners' network of providers. Implement all client network customization projects. Contact and negotiate long term contracts with out of network providers that are being accessed by the client to bring in network. • Continual interaction with existing contracted providers and network partners to assure stability and strength of relationships. • Supervise the Network Development team of 12 national contractors. Responsible for day-to-day direction, annual reviews, interviewing of incoming contractor candidates. • Monitor team productivity via phone and contact manager reporting. • Development and facilitation of comprehensive training program for new Recruitment and Credentialing staff. • Supervise Credentialing staff to fully credential all participating providers to URAC standards. Maintain credentialing database and Prime Health Credentialing Policies & Procedures. • Facilitate credentialing meeting as committee member with physician committee members on a quarterly basis to present files for approval or decline. • Prime Health URAC committee Member June 2009

*Promotion*

• Expedited negotiations for Workers Compensation and Group Health contracts across IPA networks, hospitals, and individual medical providers for inclusion in PPO and EPO networks. • Research and resolve PPO discount countResearched and resolved PPO discount and contract Coordinated and streamlined provider credentialing to enhance onboarding efficiency.ency. processes to streamline onboarding and maintain compliance with regulatory standards.ons. provider credentialing. • Maintain provider contracts and database.
• Collaborated with hiring managers to identify staffing needs and job requirements.
• Managed full-cycle recruitment processes from sourcing to onboarding candidates.
• Expedited negotiations for Workers Compensation, Group Health, and Auto long-term contracts across IPA networks, hospitals, ancillary providers, and individual and group medical providers for inclusion in PPO and EPO networks. *Renegotiated all existing Tennessee (statewide) contracts to add state mandated fee schedule discount and introduce comparison methodology. • Research and resolve PPO discount countResearched and resolved PPO discount and contract Coordinated and streamlined provider credentialing to enhance onboarding efficiency.ency. processes to streamline onboarding and maintain compliance with regulatory standards.ons. provider credentialing. • Maintain provider contracts and database.

• Led call center operations, enhancing service delivery effectiveness.
• Supported co-workers with escalated calls and issues to maintain customer satisfaction.
• Facilitate comprehensive training program of all new department staff and perform company-wide training for all new hires
• Identify industry and service trends via weekly reporting and forward relevant information to Supervisor
• Managed break and lunch schedules, ensuring optimal telephone coverage during peak times.

• Coordinated scheduling of patient appointments to optimize clinic workflow
• Pre-certified patient insurance and verified workers compensation
• Managed daily reconciliations and charge entry, ensuring financial accuracy
• Assisted with various operational tasks, contributing to overall clinic efficiency
• Transcribed medical records, enhancing accuracy of documentation