Gina Scialdoni
Belle Harbor,NY
Summary
Adept at spearheading provider relations and compliance initiatives, my tenure at Extended MLTC showcases a proven track record in enhancing provider networks and ensuring regulatory adherence. Leveraging skills in Salesforce and project management, I excel in resolving complex issues, fostering team leadership, and driving strategic improvements in healthcare settings.
Overview
18
18
years of professional experience
Work History
Director of Provider Relations
Hamaspik Choice
Spring Valley, NY
08.2023 - Current
- Ensured alignment with evolving regulatory standards and coverage options.
- Directed understanding of contractual and credentialing requirements in healthcare.
- Oversaw compliance with accreditation requirements and contractual obligations.
- Responsible for ensuring accurate data entry into system databases related to provider information updates.
- Resolved complex issues between providers and other departments in a timely manner.
- Managed grievances from providers concerning payment disputes or contractual issues.
- Updated and maintained databases with current information.
Director of Provider Relations
Extended MLTC
Staten Island, NY
11.2022 - 08.2023
- Negotiated optimal contracts with healthcare providers to maximize organizational value.
- Handled data configuration, review, and submission of Provider Network Data Systems (PNDS).
- Developed strategies to recruit providers addressing network gaps.
- Advised on strategic initiatives related to enhancing the overall provider experience.
- Advised on regulatory practices necessary for effective provider contracting and credentialing.
- Monitored compliance with payer regulations, contract provisions, network standards, and accreditation requirements.
- Collaborated closely with internal stakeholders, such as the legal department, finance department, and IT department, to ensure the successful execution of projects.
- Conducted regular meetings with providers to discuss performance metrics, quality improvement initiatives, and process changes.
- Resolved complex issues between providers and other departments in a timely manner.
- Implemented processes enhancing provider relations through staff training programs.
- Addressed grievances from providers regarding payment disputes and contractual concerns.
- Analyzed claims data for identifying discrepancies and fraud indicators.
- Updated and maintained databases with current information.
Provider Relations / SIU Supervisor
Extended MLTC
New York, NY
08.2015 - 11.2022
- Encompasses all Provider Relations and Contracting Specialist responsibilities.
- Meeting and maintaining NYS and DOH specialty, and regulatory network requirements.
- Continuously monitors the implementation of new and revised provider contracts.
- Actively provides support in contract compliance and audit initiatives to identify continuous network requirements.
- Negotiates providers' contract services, terms, and reimbursement rates.
- Delegates and oversees the maintenance, accuracy, and distribution of all single-payer agreements for out-of-network providers.
- Provide project management responsibilities as needed, which may include coordination of projects to meet the MCO’s contractual requirements with NYSDOH.
- Investigates provider issues, including but not limited to inaccurate documentation to support authorized services, lack of evidence to support claims submitted by the provider, and based on contractual requirements with the MCO.
- Oversee provider investigation of non-compliance, initiate the next course of action, and ensure all steps are documented for compliance purposes.
Provider Relations & Contracting Specialist
Extended MLTC
New York, NY
08.2013 - 09.2015
- Ensure provider information is updated accordingly through our Network Database, and distributed among internal staff.
- Responsible for the NYSDOH Health Provider Network Data Submission (HPN) Quarterly Review and submission.
- Initiates and maintains single-payer agreements with all network providers.
- Delegates and manages the outcome of the MLTC Member Satisfaction Survey.
- Outreach for the URAC Provider Network Accreditation.
- Manages the collection and follow-up of information on all provider credentialing and contracting documents.
- Actively provides support in contract compliance and audit initiatives to identify continuous network requirements per NYS regulations.
- Assist in the implementation of solutions to provider issues and problems.
Customer Care Representative
Visiting Nurse Service of New York
New York, NY
02.2010 - 08.2013
- Instituted many VNSNY projects that help raise awareness of the agency and the programs it offers, particularly to those in need of agency services.
- Document patient calls, and ensure incoming and outgoing service information is handled appropriately.
- Directly assist patients in obtaining VNSNY services and scheduling appointments with appropriate providers via new promotional programs.
- Assisted with cable ad calls for the marketing department by educating potential clients about VNSNY services available and various ways of obtaining them.
Marketing & Events Assistant
Advertising Age Publication
New York, NY
09.2007 - 03.2011
- Directly involved with event and conference planning, including speaker and guest list organization, handling of special client requests, and maintaining constant contact with corporate sponsors and exhibitors.
- Responsible for all phases of event setup, including venue and catering arrangements, selection and distribution of promotional items, and pre- and post-event operations.
- Organized and kept track of paid advertisements and promotional email blasts for each issue.
Marketing Intern
Esquire Magazine - Hearst Corporation
New York, NY
10.2006 - 05.2007
- Assisted with the setup of marketing events, event guest check-in, and overall assistance with any marketing as requested by senior staff.
- Assisted the marketing team with all special projects and events.
- Organized editorial and retail credits, keeping them up to date and accessible for reference.
Education
Bachelor of Science - Business Management, Marketing
Saint Francis College
Brooklyn, NY01.2009
Skills
- Microsoft Office Suite
- Internet database search
- Health information systems
- Salesforce proficient
- Provider Network Data System proficient
- Provider Onboarding
- Site Assessments
- Project Management
- Problem-solving aptitude
- Team Leadership
- Ensures Code Compliance
Timeline
Director of Provider Relations
Hamaspik Choice
08.2023 - Current
Director of Provider Relations
Extended MLTC
11.2022 - 08.2023
Provider Relations / SIU Supervisor
Extended MLTC
08.2015 - 11.2022
Provider Relations & Contracting Specialist
Extended MLTC
08.2013 - 09.2015
Customer Care Representative
Visiting Nurse Service of New York
02.2010 - 08.2013
Marketing & Events Assistant
Advertising Age Publication
09.2007 - 03.2011
Marketing Intern
Esquire Magazine - Hearst Corporation
10.2006 - 05.2007
Bachelor of Science - Business Management, Marketing
Saint Francis College
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