Kande Greene, CMC
Navarre,OH
Summary
With a proven track record at The Health Plan, I excel in provider pricing and contract programming, demonstrating leadership in team management and efficiency improvements. My expertise spans multi-state managed care plans, enhancing accuracy and compliance. Skilled in both technical configurations and fostering educational growth, I significantly contribute to operational excellence and strategic provider relations.
Overview
27
27
years of professional experience
Work History
Manager of Provider Pricing
The Health Plan
05.1998 - Current
Responsible for the programming of all provider contracts as well as auditing and compliance of those contracts across multiple lines of business.
Education
Certified Medical Coder - Medical Coding
Practice Management Institute
San Antonio, TX11-2021
Bachelor of Arts - Education
Walsh College
North Canton, Ohio05-1989
Bachelor of Science - Biology
Walsh College
North Canton, Ohio05-1987
Skills
- Responsible for provider pricing/configuration for hospital and ancillary providers in a multi-state, multi-product managed care plan
- Provide team leadership, support and assign work and manage provider pricing inventory
- Identify provider education opportunities
- Provide education to internal teams on pricing updates, including financial impact to provider and health plan
- Obtain published government program fee schedules, pricers and updates for system configuration
- Assist with external audits by gathering documentation to support pricing/contract configuration
- Identify and implement process improvements to increase efficiency, accuracy and completeness
- Active in claims payment issues
- Develop and maintain training manuals
- Auditing of claims for contract pricing configuration accuracy
- Develop new line of business pricing and configuration in claims payment system
- Configuration of all contracts for all lines of business into new claims payor system
Timeline
Manager of Provider Pricing
The Health Plan
05.1998 - Current
Certified Medical Coder - Medical Coding
Practice Management Institute
Bachelor of Arts - Education
Walsh College
Bachelor of Science - Biology
Walsh College
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