Kelli Asher
Sparks,NV
Summary
Results focused leader with over 10 years of experience in Provider Network Development and Management. Skilled in all aspects including contract negotiations/re-negotiations, service area expansion, shared savings, quality programs, capitation, value based contracting, provider relations, provider data management and credentialing.
Overview
10
10
years of professional experience
Work History
Director, Network Management
Prominence Health Plan
01.2020 - 07.2023
- Developed and negotiated value based, capitation and shared savings contracts
- Implemented strategic initiatives in collaboration with health plan operations team and executive leadership
- Managed and led team of negotiators for hospital, ancillary and physician contracts for commercial HMO, PPO and Medicare Advantage
- Led network expansion in southern Nevada for commercial HMO and PPO for sales department growth initiative
- Performed detailed rate analyses, provider gap analyses and developing overall network development strategy for HMO, PPO and Medicare Advantage
- Managed Provider Relations team across multiple markets/states to ensure performance metrics, including tracking, monitoring and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures were met
- Led successful Service Area Expansion (SAE) and network development initiatives for Palm Beach county Florida
- Implemented new online form system for credentialing, provider demographic changes, letter of intent, etc.
- Oversaw Supervisor of Credentialing and Provider Data Management Department to ensure timeliness and compliance with state, federal and regulatory agencies
- Oversaw operations and provided corrective feedback to achieve daily and long-term goals
Sr. Manager, Network Management
Prominence Health Plan
05.2018 - 01.2020
- Development and retention of a comprehensive provider network of hospital, ancillary, physician and supplemental service providers, which meet state and federal time and distance standards for access and availability
- Meet with facility, hospital and ancillary providers to educate and change practice patterns and refine network accordingly to meet fiscal and compliance targets
- Meeting with large volume, high dollar and other important providers personally
- Facilitated the management and integration of Provider Relations activities to assure timely and accurate resolution of complex and sensitive provider issues
- Created and Implemented new policies and procedures to improve processes for Credentialing and Provider Data Management Departments
Manager, Provider Network
Prominence Health Plan
01.2015 - 04.2018
- Network expansion of Medicare Advantage product to 16 new counties in multiple states
- Developed, managed and maintained a comprehensive provider network of hospital, ancillary and physician agreements for commercial HMO, PPO and Medicare Advantage
- Managed and executed network expansion from leased network to owned network in southern Nevada for commercial HMO and PPO
- Negotiated agreements for hospital, ancillary and physicians
- Ensure network adequacy at all times in accordance with state and federal regulation. Prepare and file network reports including HSD tables, GeoAccess analysis, etc.
- Developed and executed provider education seminars for all markets on an annual basis
- Developed and execute new provider onboarding training
- Negotiated one time Letter of Agreements (LOA) for non-contracted providers
- Disruption reports for Request for Proposals (RFPs)/new bids
Payor Relations
Prominence Health Plan - NPHP
02.2013 - 12.2014
- Responsible for contracting and negotiating rates for PPO leased network to health plans/payers
- Performed payer/client analysis
- Prepared and distributed monthly tier reports
- Negotiated new rates for leased network clients
- Prepared and managed contracts for leased network clients
Education
Bachelor of Science - Interior Design
University of Nevada Reno
Reno, NV12.2003
Skills
- Contract negotiations
- Network development
- Service Area Expansion (SAE)
- Contract redline and review
- Computer skills/programs: Microsoft 365, Quest Analytics, CAQH, Zelis, QNXT, Smartsheet, Aaneel, Quickbooks, AutoCAD
Timeline
Director, Network Management
Prominence Health Plan
01.2020 - 07.2023
Sr. Manager, Network Management
Prominence Health Plan
05.2018 - 01.2020
Manager, Provider Network
Prominence Health Plan
01.2015 - 04.2018
Payor Relations
Prominence Health Plan - NPHP
02.2013 - 12.2014
Bachelor of Science - Interior Design
University of Nevada Reno
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