Ieshe Hale
Houston
Summary
Demonstrated achiever with over five years’ experience in managed care, provider relations, network development, recruitment, Medicare, Medicaid, CMS guidelines and customer service. Skilled at working under pressure, learning new skills, communicating effectively and clearly. Enthusiastic and motivated with morals and a strong work ethic.
Overview
7
7
years of professional experience
Work History
Provider Network Manager
Health Net Federal Service
05.2023 - 05.2024
- Oversees provider contract negotiations – hospitals, ancillaries, and groups.
- Submit and review credentialing applications
- . Develops provider contracting strategies
- Monitors network adequacy and resolves hospital provider claim issues
- Oversees network analysis for adequacy and recruitment targets
- Provide regional input and maintenance of provider directory
Sr Network Development & Contract Specialist
BlueSprig Pediatrics
09.2018 - 02.2023
- Responsible for network development; monitoring and managing the contractual relationship of assigned
- Negotiate contractual rates based on the CEO requirements for reimbursement
- Enroll provider with state and commercial payors
- Provide updates on credentialing status
- Assists payors in resolving managed-care issues related to various entities of the integrated delivery system
- Ensures final contract documents are maintained and are consistent with negotiated agreements.
Internal Network Representative II
BCBSTX
06.2017 - 09.2018
- Provided assistance to practitioners in resolution of claims, pricing, coding and contract issues.
- Acting liaison with providers through education, training, claims assistance and ongoing provider service.
- Working with internal departments to evaluate and resolve provider/contract and service issues.
Education
Bachelor of Science - Health Administration
University of Phoenix
10.2017
Skills
- Network Management
- Contract Negotiations
- Credentialing
- Medicaid Medicaid and Commerical payors
Timeline
Provider Network Manager
Health Net Federal Service
05.2023 - 05.2024
Sr Network Development & Contract Specialist
BlueSprig Pediatrics
09.2018 - 02.2023
Internal Network Representative II
BCBSTX
06.2017 - 09.2018
Bachelor of Science - Health Administration
University of Phoenix
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