LATONYA GEORGE
HUMBLE,TX
Summary
Highly motivated employee with third party administration experience, both full risk and shared risk desire to take on new challenges. Strong worth ethic, adaptability, and exceptional people skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
12
12
years of professional experience
Work History
Contract Administrator
Texas Children Hospital
Houston, TX
11.2023 - Current
- Work with Legal and Credentialing teams to finalize provider contracts, including amendments and new agreements.
- Negotiate contract language and rates with hospital and physician in accordance with established parameters and guidelines.
- Draft, review, and revise contracts for accuracy and completeness.
- Conducts and participates in quarterly JOC meetings with assigned health plans.
- Develop rate proposals using Excel-based modeling tools and work with Actuarial to obtain all other rate and utilization analytics needed to support contract negotiations.
- Negotiate single case agreements for hospital and physician group with non-contracted health plans.
- Work with internal departments to resolve network management issues.
- Conduct trainings with other departments on new initiatives.
- Other duties as assigned by management.
Sr. Provider Relations Liaison
Kelsey-Seybold Clinic
Houston, TX
03.2022 - Current
- Assist in coordinating provider agreements, amendments, letters of agreements with contracted and non-contracted providers
- Prepare contract packages for potential providers, track, and ensure credentialing process if complete
- Maintain and maintain provider file folders and provider online databases
- Responsible for loading all new provider contracts and contract changes in internal database
- Conduct new provider orientations and quarterly Joint Operating Committee (JOC) meetings
- Educate providers on new initiatives, policies, and procedures
- Research and resolve any claim discrepancies with providers
- Analyze, prepare, and review cost trend reports by services types and providers
- Recruit new providers to meet network adequacy standards
- Other duties as assigned by management
Ancillary Contractor
IntegraNet Health
Houston, TX
11.2020 - 03.2022
- Negotiated contracts with outside providers to minimize costs to company and customers
- Managed the contracting process at the market level
- Tracked recruitment and assisted in business development activities
- Coordinated the development of professional, effective relationships within area hospitals, physicians, and ancillary providers
- Developed and created marketing material to support market level initiatives and campaigns
- Developed contract templates and updated policies and procedures to maintain contracting consistency
- Served as point of contact for general inquiries from business owners and leadership regarding vendor contracts
- Understood and explained fee schedules and reimbursement methodologies with providers
- Recruited new providers to reduce network adequacy
- Other duties as assigned by management
Provider Relations Representative
IntegraNet Health
Houston, TX
11.2017 - 10.2020
- Recruited new physicians and implemented new business strategies consequently by enhancing the network
- Secured LOA's (letter of agreements) with both contracted and non-contracted providers
- Increased client/vendor satisfaction through efficient resolution of complex billing, quality of care issues with both internal and external clients
- Proactively identified vendor/client needs by assisting to resolve and communicate concerns or complaints regarding risk/non-risk programs in order to maintain satisfaction
- Supported vendor/client data integrity and contractual payment processes
- Investigated and understood fee schedules and reimbursement methodologies
- Reviewed and negotiated contractual terms to ensure minimized risk exposure and maximum profitability
- Reviewed and managed client draft contractual terms and contract requirements
- Conducted new provider site visits and orientations with office staff
- Identified open network GAPS within assigned territory
- Educated and reviewed HEDIS information with provider practices
- Other duties as assigned by management
Provider Services Representative II
Molina Healthcare Inc
Houston, TX
12.2011 - 11.2017
- Assisted and resolved external clients/vendors with billing discrepancies
- Supported vendor data integrity and contractual payment processes
- Educated external clients/vendors on new programs and initiatives
- Recruited new physicians and implemented new business strategies consequently by enhancing the network
- Built and nurtured positive relationships with external clients/vendors
- Proactively identified vendor/client needs by assisting to resolve and communicate concerns or complaints regarding risk/non-risk programs in order to maintain satisfaction
- Planned outreach events for external clients/vendors
- Assisted in training of new hires within the department
- Other duties as assigned by management
Education
Bachelor of Science - Interdisciplinary Studies
University of Houston
05.2010
Skills
- Microsoft Office
- CACTUS
- QNXT
- EPIC
- CAQH
- Availity
- Contract analysis
- Contract amendments
- Contract negotiation
- Data management
Timeline
Contract Administrator
Texas Children Hospital
11.2023 - Current
Sr. Provider Relations Liaison
Kelsey-Seybold Clinic
03.2022 - Current
Ancillary Contractor
IntegraNet Health
11.2020 - 03.2022
Provider Relations Representative
IntegraNet Health
11.2017 - 10.2020
Provider Services Representative II
Molina Healthcare Inc
12.2011 - 11.2017
Bachelor of Science - Interdisciplinary Studies
University of Houston