Summary
Overview
Work History
Education
Skills
Timeline
Generic

Jennifer Gray

Pekin,IL

Summary

Managed Care Specialist with diverse knowledge at Carle Health in optimizing direct-to-employer relations and claims management. Successfully negotiated contracts securing favorable terms, enhancing network development through strategic outreach. Adept at fostering teamwork and collaboration, ensuring accurate reimbursements and maintaining provider rosters for seamless operations.

Overview

22
22
years of professional experience

Work History

Managed Care Specialist

Carle Health
04.2003 - Current
  • Actively manage a direct-to-employer (DTE) network by coordinating all contracting and relationships between employers, third-party administrators (TPA's), brokers and healthcare providers
  • Oversee managed care claims and fee schedules ensuring accuracy of reimbursements including re-pricing of claims for employers
  • Supported network development efforts through proactive outreach to potential providers and initiation of contracting processes.
  • Assisted in negotiating contracts with payors securing favorable terms for both providers and the organization.
  • Maintain and audit provider rosters for payors
  • Prepare applications for facility credentialing to ensure in-network status with payors
  • Coordinate and attend health fairs and events to promote network participation
  • Collaborate with departments within the hospital system to provide assistance with payment variances, contracting terms, and network issues

Education

Bachelor of Science -

Illinois State University
Normal, IL
05-2006

Skills

  • Healthcare
  • Relationship building
  • Network problem solving
  • Provider relations
  • Claims management
  • Managed care expertise

Timeline

Managed Care Specialist

Carle Health
04.2003 - Current

Bachelor of Science -

Illinois State University

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