Summary
Overview
Work History
Education
Skills
Websites
Timeline
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Johnathan Chambers

Atlanta,GA

Summary

Experienced supervisor with a proven track record of leading and motivating team members to consistently complete jobs on time. Skilled in assigning tasks, training employees, and implementing company procedures to ensure efficient operations. Possesses excellent communication and listening skills, enabling effective collaboration and problem-solving. A visionary leader who drives teams to meet goals and consistently delivers high-quality results. Offers over 15 years of diverse experience in analytics, contracting, network development, quality improvement, auditing, call center operations, payment policies, project plans, RFP responses for state/federal compliance measures, claims management, creating/maintaining P&Ps, work flows, staff development, system/benefit configuration, training, management oversight, and trend and strategy implementation.

Overview

18
18
years of professional experience

Work History

Supervisor of Contract Implementation Systems

DELTAL DENTAL of CALIFORNIA
09.2022 - Current
  • Tasks include the oversight of daily operations of benefit configuration for the largest domestic dental provider consisting of 40M+ enrollees, over 70K providers, and multiple subsidiary divisions
  • Identify appropriate measures to configure complex asks via feasibility opportunities
  • Manage multiple configuration service types to include benefits, finance, billing, claims, and provider network; maintaining SLA with quality as the primary focus to mitigate risks
  • Acts as the intermediary for any escalations and ensure to work with partners to bring resolution; minimizing impacts to stakeholders

Senior Contract Implementation Analyst

CENTENE CORPORATION (Meridian-Michigan Complete Health)
06.2020 - 09.2022
  • Duties consists of performing day to day managed care operations which entail complex contract implementation testing; including multiple systematic UAT to ensure systems accurately reflect a contract’s negotiated terms of new or non-standard benefits/pricing
  • Complete claim analysis using SQL Teradata and Golden
  • Fully integrated & configured Meridian Complete’s MMP into the legacy Centene systems/platforms due to the acquisition whilst coordinating tasks w/ international team in India and Taiwan
  • Operational excellence by assisting with best practices as a SME through collaborative efforts to ensure the mitigation of financial risks and compliance to State/Federal regulations

Senior Contract Negotiator

CENTENE CORPORATION (Peach State Health Plan)
03.2019 - 06.2020
  • Tasks comprises of all Negotiator I duties plus managing the contracting efforts of medical & behavior health teams, coordinating transplant agreements, facilitate all escalated regulatory complaints, ensure compliance to CFRs, provide plan wide direction on daily operations, and manage projects for operational excellence
  • Successfully built Commercial-Exchange network for new Tennessee market; ensuring all geographical access requirements were met and assisted with training new team
  • Operational lead for P&Ps/workflows while drafting facility/ancillary/professional services contracts to include hospitals, ASCs, BH, and other service types

Contract Negotiator I

CENTENE CORPORATION (Peach State Health Plan)
01.2018 - 03.2019
  • Duties encompassed contracting various medical/behavior health professionals or facilities, managing IPA/PHO networks/relations, strategize network development for multiple states, ensure compliance to regulatory requirements, seek competitive advantage, and drive AOP initiatives to include value based/P4P/HBR for quality improvement
  • Successfully closed multiple subspecialty gap types within rural areas to ensure network adequacy of 99% with providers whom high verified high quality scores via CMS
  • Increased HBP contracts with high utilization and financial cost to decrease organizational operational costs of OON providers within emergency settings

Contracting Specialist

PRESTIGE STAFFING
07.2017 - 01.2018
  • Tasks included network development by contracting various physicians, medical groups, specialists, ancillary (durable medical equipment, ambulatory surgery centers, home health, infusion centers, etc.), and hospitals; including singe case agreements or letters of agreement
  • Assisted in the claim processing of various projects for strong financial institutions to decrease aging claims, interest amounts, provider A/R, and prevent additional provider abrasion
  • Contracted various providers within the state of Georgia to include negotiating reimbursement terms to ensure organizational profitability, attainment of all documents to fully execute contract, and provided initial consultation upon contract implementation

Trainer I

CENTENE CORPORATION (Peach State Health Plan)
01.2015 - 11.2016
  • Duties included operational analysis, claims processing, State manual reviews, coordination of system configuration for payment, creating training materials, network communications, external stakeholder training, and resolution of State or Department of Insurance complaints
  • Reviewed provider claim submissions, third party vendor oversight for recovery, partnership with Verisk to ensure compliance to CMS’ National Correct Coding Initiatives (Medically Unlikely Edits & Procedure-to-Procedure Edits), and understanding various reimbursement methodologies
  • Managed the company’s first Real Time Editing & Pricing functionality with staggered deployment to 40 unique provider groups with full network implementation scheduled (increasing utilization 27%)

Quality Improvement Specialist II

CENTENE CORPORATION (Peach State Health Plan)
08.2014 - 01.2015
  • Responsibilities included assisted supervision of staff with daily productivity of set calls per day, adherence within 90%, quality trends/analysis, and provided departmental/side by side coaching/training for development as well as staff retention
  • Increased quality scores by 15% with initiatives to identify best practices to decrease talk times, increase customer satisfaction, and enhance department moral
  • Ensured compliance to meeting 85% overall score via monthly State Collaborations

Quality Improvement Specialist I

CENTENE CORPORATION (Peach State Health Plan)
01.2007 - 08.2014
  • Duties included assuring billing, material requests, contracting, credentialing, system configuration, member/provider demographics, and other concerns where focus on informational accuracy of Medicare Advantage Special Needs Program, Medicaid Care Manage Organization, and Affordable Care Act per federal/state mandated contractual obligations is conveyed
  • Improved quality standards of internal (call center- 31%) and external (territory/field representatives- 40%) staff for various inquiries pertaining to Member/Provider Rights
  • Exceed State contractual guidelines 10% by collaborating on a monthly basis with all health plans to discuss best practices and ways to optimize the call monitoring system

Education

MBA - BBA Specialization in Management

American InterContinental University

Certified Medical Reimbursement Specialist -

American Medical Billing Association

Skills

  • Decision-making
  • Team building
  • Training and mentoring
  • Attention to detail
  • Staff management
  • Relationship building
  • Priority management
  • Operations management
  • Strategic planning
  • Employee motivation
  • Processes and procedures
  • Staff development

Timeline

Supervisor of Contract Implementation Systems

DELTAL DENTAL of CALIFORNIA
09.2022 - Current

Senior Contract Implementation Analyst

CENTENE CORPORATION (Meridian-Michigan Complete Health)
06.2020 - 09.2022

Senior Contract Negotiator

CENTENE CORPORATION (Peach State Health Plan)
03.2019 - 06.2020

Contract Negotiator I

CENTENE CORPORATION (Peach State Health Plan)
01.2018 - 03.2019

Contracting Specialist

PRESTIGE STAFFING
07.2017 - 01.2018

Trainer I

CENTENE CORPORATION (Peach State Health Plan)
01.2015 - 11.2016

Quality Improvement Specialist II

CENTENE CORPORATION (Peach State Health Plan)
08.2014 - 01.2015

Quality Improvement Specialist I

CENTENE CORPORATION (Peach State Health Plan)
01.2007 - 08.2014

Certified Medical Reimbursement Specialist -

American Medical Billing Association

MBA - BBA Specialization in Management

American InterContinental University
Johnathan Chambers