Kathy Oplinger
Parkersburg
Summary
Results-driven professional with expertise in contract negotiation and strategic planning. Demonstrated success in leading teams to enhance provider relationships and achieve compliance with regulatory standards.
Overview
33
33
years of professional experience
Work History
Director, Kentucky & West Virginia Marketplace
CareSource
11.2005 - 04.2026
- Responsible for executing the Health Partner contracting strategy, developing contract provisions based on cost, quality/analysis and monitor key metrics for the Market
- Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting initiatives
- Responsible for provider recruitment, contracting and initiating the loading and credentialing processes
- Create contract language and review with legal to develop approved contract templates specific to the assigned Market and within the established corporate guardrails
- Analyze financial data and establish rates in collaboration with Provider Contracting leadership and Finance
- Negotiate and re-negotiate hospital, ancillary, physician and behavioral health contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
- Build networks to support new products within the market and on-board new providers
- Responsible for complying with all regulatory requirements
- Perform gap analysis to ensure no gaps and/or sanctions occur; identify potential providers to recruit that will fill the gaps; identify and implement solutions that mitigate risk; develop corrective action plans as needed
- Knowledgeable of federal and state laws and regulations pertaining to provider contracting
- Assist with development and review of payment policies and provider notifications
- Identifies and fosters communications with Health Partners to reduce high cost utilization trends; possesses a strong financial acumen to ensure Health Partner contract financial targets are met and/or exceeded
- Works with Health Partner stakeholders to evaluate policy and process changes for potential impacts, monitors implementation of key initiatives, and provides leadership on key initiatives affecting Health Partners
- Manages Health Partner Relations team that conducts research into Health Partner issues and drives them to completion for the Health Partner network
- Actively engages Health Partner associations and Health Partners to identify opportunities to strengthen relationships and identify collaboration opportunities
- Ensures CareSource complies with regulatory requirements, addresses compliance concerns, achieves accreditation standards and participates in market audits
- Provides education, leadership, analysis and ongoing support in the areas of Cost of Care, Value-Based Reimbursement, and cost saving initiatives for the Health Partner relations team and the Health Partner Network
- Understands change management, translates goals and objectives into practical integrated solutions, and delivers on financial value to the Health Partner and CareSource
- Provides regional leadership to cross functional teams while coordinating services and support to achieve all market goals set forth by the Market
- Responsible for hiring, managing and ongoing training of the Health partner relations team, providing leadership and coaching to staff on strategy, best practices and professional development and developing and maintaining high team engagement
Manager of Provider Contracting
Cigna
05.1993 - 11.2005
- Led contract negotiations with providers including, hospitals, physicians, ancillaries, and large healthcare systems
- Tracked and analyzed financial performance of provider contracts to determine if the financial goals set were being met.
- Led cross-functional teams to enhance operational workflows and service delivery.
- Developed strategic initiatives to improve provider satisfaction.
- Collaborated with stakeholders to identify process improvement opportunities across departments.
- Implemented training programs, mentoring staff to ensure adherence to quality standards.
Education
Bachelor of Arts - Education
Edinboro University of Pennsylvania
Edinboro, PA05-1988
Bachelor of Science - Psychology
Ohio University
Athens, OH05-1984
Skills
- Contract negotiation
- Strategic Planning
- Decision-making
- Issue resolution
- Contract and vendor management
- Clear and concise communication
- Legal and regulatory compliance
Timeline
Director, Kentucky & West Virginia Marketplace
CareSource
11.2005 - 04.2026
Manager of Provider Contracting
Cigna
05.1993 - 11.2005
Bachelor of Arts - Education
Edinboro University of Pennsylvania
Bachelor of Science - Psychology
Ohio University