HARSHIT PATEL
Tampa
Summary
Dynamic Provider Network Manager specializing in optimizing provider relationships and contract negotiations for Medicare and Medicaid services. Achieved significant cost savings while enhancing vendor performance through strategic collaboration and compliance initiatives. Proven track record in driving operational efficiency across multiple counties.
Overview
15
15
years of professional experience
Work History
PROVIDER NETWORK MANAGER, SR.
Elevance Health, Inc
Tampa
01.2025 - Current
- Managed statewide medical and non-medical vendors for Medicare and Medicaid programs, ensuring compliance and service quality.
- Collaborated with leadership and internal departments to maintain vendor compliance and monitor KPIs.
- Evaluated contracts and negotiated options to maximize cost efficiency.
- Reviewed vendor configurations to ensure accuracy in claim processing.
- Led monthly meetings and quarterly joint operating committees with vendors.
- Educated vendors to enhance operational efficiency.
- Performed various tasks to support team operations.
PROVIDER NETWORK MANAGER II
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
Tampa
09.2016 - 12.2024
- Negotiated complex provider contracts based on market analysis to optimize agreements.
- Managed provider contracting and relationships with all participating providers in Pinellas and Pasco counties.
- Identified and recruited providers to address service gaps, expanding network capacity and accessibility.
- Educated network providers and supported office staff, improving operational efficiency and service delivery.
- Conducted quarterly meetings with providers to align on needs and expectations, fostering collaboration.
- Acted as liaison between providers and internal departments to resolve member benefits and claims issues.
- Performed gap analysis to prevent sanctions and ensure comprehensive coverage.
- Collaborated with internal departments to maintain accuracy of network directory.
PROVIDER CLAIMS RESEARCH - HOSPITAL & PHYSICIAN
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
01.2014 - 09.2016
- Reviewed UB claims with hospitals to ensure compliance and accuracy, facilitating timely reimbursements.
- Collaborated with delegated provider groups to analyze monthly A/R reports, identifying trends and improving claim resolution processes.
- Resolved claims issues for participating and non-participating providers, enhancing provider satisfaction.
SENIOR MEMBER SERVICES REPRESENTATIVE
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
09.2011 - 12.2013
- Assisted members by answering calls regarding benefits, authorization, and claims to ensure clarity and understanding.
- Assisted members with inquiries regarding health plans and services.
- Educated members on benefits and coverage options effectively.
- Assisted Tier I callers with inquiries and resolved complex concerns/complaints to enhance member satisfaction.
- Processed member enrollment and renewal applications accurately.
Education
BUSINESS -
HILLSBOROUGH COMMUNITY COLLEGE
07-2012
Skills
- Medicare Medicaid knowledge
- CMS guidelines knowledge
- Contract management
- Provider relationship management
- Value-based contracting strategies
- CAQH proficiency
- Microsoft Office proficiency
- Leadership
- Team collaboration
- Effective communication
Timeline
PROVIDER NETWORK MANAGER, SR.
Elevance Health, Inc
01.2025 - Current
PROVIDER NETWORK MANAGER II
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
09.2016 - 12.2024
PROVIDER CLAIMS RESEARCH - HOSPITAL & PHYSICIAN
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
01.2014 - 09.2016
SENIOR MEMBER SERVICES REPRESENTATIVE
FREEDOM HEALTH & OPTIMUM HEALTHCARE, INC
09.2011 - 12.2013
BUSINESS -
HILLSBOROUGH COMMUNITY COLLEGE