Hi, I’m
LASHA MOORE
Network Development
Marietta,GA
Summary
An innovative, healthcare professional with a strong contracting, provider relations, and project Management background. Over 16 years of managed care experience, which includes account management, developing and managing networks, conducting geo deficiencies reviews, proactively identifying provider and or vendor needs, adhering to project deadlines and communicating effectively regarding project risks, An experienced facilitator in presentations to C Suite executives, Hospital administrators, physicians, staff, and employees.
Overview
17
years of professional experience
Work History
Ewings Network Solutions
Provider Network Contractor/Consultant (Remote)
08.2021 - Current
Job overview
- Prepare, analyze, and review network performance against required access standards.
- Negotiate and build a stable provider network that achieves objectives for unit cost performance and trend management
- Evaluate and negotiate contracts with healthcare providers in compliance with contract templates, reimbursement structure standards, and other key process controls.
- Establish and maintain relationships with healthcare providers and ensure the network composition includes an appropriate distribution of provider specialties.
- Provide explanations and interpretations for the provider network roster
Envolve Benefit Options
National Account Manager
11.2017 - 07.2021
Job overview
- Account Management oversight services rendered to Health Plans Located in Georgia, Mississippi, Michigan, and Tennessee. 7 Health plans with various Lines of Business (Medicaid, Medicare MAPD, Medicare DSNP, MMP, and Ambetter). Product: Dental Benefits Manager and Vision Benefits Manager.
- Manage key Health Plan Accounts , client relationships, and complete Dental and Vision Dashboards for Health Plan by Line of Business
- Monthly Operations Meetings and Joint Operations Committee Meetings held with Health Plan Clients to review quarterly Dental and Vision performance for Lines of Business (Medicare, Medicaid, MMP, and Ambetter)
- Assist in the project management of all contract implementations and in the establishment of strong account relationships while ensuring a smooth transition of services for members.
- Provide education and training to Health Plan Clients regarding Benefits, Reporting issues, address State concerns and inquiries internally and externally
- When applicable - attend and complete scheduled site visits, ZOOM calls and Annual Vendor Delegation Meetings
- Act as liaison for Envolve and Health Plan and departments
- Coordinate with the Quality Improvement department for the tracking of complaints/concerns and ensure timely follow-up, including resolution with all appropriate operations and/or corporate staff.
- Collaborate with external Health Plan Partners to resolve complex issues related to member, provider, and state concerns. problems complaints identified by accounts and manage account issues to closure
- Translate ideas and client requests into actionable items for the operations, call center or product development team to enhance service delivery or new product offerings.
Peach State Health Plan
Provider Relations Manager
05.2013 - 11.2017
Job overview
- Manage day-to-day provider relations activities and provider relations department.
- Maintain production and quality standards Initiate and execute standard physician, ancillary, and home and community based service provider contracts.
- Coordinate all pre-contract activities with providers such as, site visits, credentialing, orientation to contractual requirements, etc.
- Maintain contracts and correspondence files in organized and accessible manner for all providers.
- Prepare and analyze information to evaluate the need for additional health plan providers.
- Manage and coordinate customized provider contracts.
- Continually improved knowledge, skills and performance based on feedback and self-identified professional developmental needs.
- Identified process improvements in the day-to-day functioning of the department.
- Routinely collaborated with department managers to correct problems and improve services.
- Strategically planned methods to achieve operational goals and targets.
Peach State Health Plan
Project Manager II
05.2011 - 07.2013
Job overview
- Oversight of Medical Management's Provider Incentive Program Tracking, creating and maintaining the Gantt chart Plan.
- Planning the quarterly visits for the provider groups that satisfactorily met the incentive goals, provide reports and discuss progress.
- Attend/facilitate all Delegated Vendor Oversight Departmental meetings, recorded minutes, track progress and follow-up with vendor issues.
- Ensure that all vendors/clients satisfy contractual goals and adhered to a tracking system to monitor performance standards.
- Facilitate and organize the Health Plan's bi-weekly operational meetings, facilitate, coordinate, and maintain a matrix of outstanding items and follow-up with the appropriate business owners prior to the next scheduled meeting.
- All items housed on company's Intranet (SharePoint).
- Routinely collaborated with other department managers to correct problems and improve services.
- Verified data integrity and accuracy.
- Compiled, validated and updated all required materials needed for Provider Incentive Meetings
- Responded to Provider and Delegated Vendor Requests via telephone and email.
- Analyzed departmental documents for Provider Incentive Meetings and report compiliation
- Produce Travel Iterariers for Provider Incentive Trips
- Conducted follow-up prior to meetings to ensure that all responses were reviewed and completed prior to meeting.
Peach State Health Plan
Senior Communications Specialist
05.2006 - 05.2011
Job overview
- Plan, research, write, and edit articles for insertion in Provider and Member Newsletters, collaborating with the Corporate Director of Communications and Public Affairs to meet production deadlines.
- Primary contact for Provider and Member Web Site management at the health plan level.
- Coordinate internal and external marketing efforts to promote special programs/events, including, but not limited to planning, writing, designing printed materials, events planning, and developing mailing lists.
- Assist health plan internal department's development of newsletters, flyers, and memos.
- Introduced new mailing systems, vendors, and project initiatives to save money and meet budgetary goals.
- Implemented the Intranet/Share Point heath plan wide with the assistance of corporate IT.
Education
American Intercontinental University Atlanta, Georgia
MBA
03.2022
Ashford University
Bachelor of Arts from Communications Studies
09.2016
Stanton College Preparatory School High School
High School Diploma
1993
Skills
- Project Management
- Network Development
- Contract Negotiations
- Provider Relations
- Territory Management
- Presentation Skills/Meeting Facilitation
Timeline
Provider Network Contractor/Consultant (Remote)
Ewings Network Solutions
08.2021 - Current
National Account Manager
Envolve Benefit Options
11.2017 - 07.2021
Provider Relations Manager
Peach State Health Plan
05.2013 - 11.2017
Project Manager II
Peach State Health Plan
05.2011 - 07.2013
Senior Communications Specialist
Peach State Health Plan
05.2006 - 05.2011
American Intercontinental University
MBA
Ashford University
Bachelor of Arts from Communications Studies
Stanton College Preparatory School High School
High School Diploma
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