Maribel Rivera-Grant
Summary
Accomplished leader with a proven track record at Carelon Behavioral Health, adept in contract negotiation and team development. Spearheaded initiatives recovering over $3.5M, significantly enhancing operational efficiency and provider satisfaction. Expert in strategic planning and relationship building, consistently driving performance and partnership growth.
Overview
27
27
years of professional experience
Work History
Regional Director
Carelon Behavioral Health
Mid-Atlantic Market
08.2023 - Current
- Company Overview: An Elevance Company.
- Lead a team of 20 professionals, including Network Managers, Provider Quality Managers, and Provider Relations specialists, to execute recruitment and access strategies, including Value-Based Payments (VBP), and cost-of-care initiatives.
- Drive reimbursement standards, and oversee network expansion and contract negotiations with behavioral health providers, including hospitals and physicians.
- Collaborate across divisions to address complex issues, leveraging data analysis to optimize healthcare networks, and improve cost-efficiency.
- Enhance system capabilities to ensure accurate and timely claims payments, boosting provider retention and satisfaction.
- Facilitate quarterly Joint Operating Committees (JOCs) to evaluate and improve key partners' financial and operational performance.
- An Elevance Company.
Senior Director
The Mount Sinai IPA
New York, NY
06.2020 - 08.2023
- Company Overview: MSHS
- Directed the Provider Solutions team, overseeing payer contracting, negotiations, analytics, and compliance for the Independent Practice Association (IPA)
- Collaborated with the Central Billing Office and Patient Financial Services to resolve claims issues and ensure contractual compliance
- Provided leadership across multiple management layers, enhancing operational efficiency and team performance
- Successfully negotiated settlement agreements, recovering $3M for the Anesthesia department and $500K for the Emergency Department
- Managed a provider network of 4,000+ employed physicians and 350 voluntary physicians, handling contract renewals and annual dues collection
- Spearheaded initiatives to resolve enrollment delays, releasing $8M in pending claims for critical departments
- MSHS
Director, Provider Network
Anthem/Empire BCBS
New York, NY
04.2012 - 06.2020
- Led cost-saving initiatives across New York, driving significant operational efficiencies
- Managed network development for commercial, Medicare, and Medicaid lines of business
- Negotiated complex contracts with large hospital systems, physician groups, and ancillary providers across the NY Tri-state area
- Oversaw the NY/NJ Ambulatory Surgery Network from 2018 to 2020
- Trained and mentored network management consultants, enhancing provider satisfaction and claims issue resolution
- Directed quarterly Joint Operating Committees (JOCs) to assess key partners' financial and operational performance
Assistant Director, Provider Network Management
Aetna
New York, NY
04.1998 - 04.2012
- Led the Provider Relations team in the Metro New York market, managing relationships with large hospital systems, affiliated groups, and ancillary providers
- Negotiated and renegotiated contracts to strengthen network partnerships and ensure service quality
- Resolved complex contract loading issues, improving operational workflows and contract implementation
- Spearheaded system improvement projects for provider directories and claims, enhancing accuracy and efficiency
- Conducted annual staff performance evaluations and facilitated bonus programs to recognize top performers
Education
Bachelor of Arts - General Studies with a concentration in Communication
Southern New Hampshire University (SNHU)
06.2024
Communications -
State University of New York (SUNY) at New Paltz
01.1991
Skills
- Contract Negotiation
- Managed Care
- Leadership & Team Development
- Strategic Planning
- Operational Efficiency
- Effective Communication
- Performance reporting
- Meetings and presentations
- Client relationships
- Relationship building
- Customer satisfaction
- Employee recruitment
- Team evaluation
- Competitor analysis
- Staff oversight
- Operations management
- Strategic marketing
- Public speaking
- Staff training and development
- Partnership development
- Staff management
References
Available upon request
Accomplishments
- Elevance Action Award
Timeline
Regional Director
Carelon Behavioral Health
08.2023 - Current
Senior Director
The Mount Sinai IPA
06.2020 - 08.2023
Director, Provider Network
Anthem/Empire BCBS
04.2012 - 06.2020
Assistant Director, Provider Network Management
Aetna
04.1998 - 04.2012
Bachelor of Arts - General Studies with a concentration in Communication
Southern New Hampshire University (SNHU)
Communications -
State University of New York (SUNY) at New Paltz
Similar Profiles
Christina BrownChristina Brown
Customer Service Rep at Carelon Behavioral Health (Elevance Health)Customer Service Rep at Carelon Behavioral Health (Elevance Health)
Jeffrey P. HockingJeffrey P. Hocking
Training Specialist at Carelon Behavioral HealthTraining Specialist at Carelon Behavioral Health
Denzel G. Flores SolerDenzel G. Flores Soler
Customer Service Representative at Carelon Behavioral HealthCustomer Service Representative at Carelon Behavioral Health
Kathleen ConnallyKathleen Connally
Clinical Service Assistant at Carelon Behavioral HealthClinical Service Assistant at Carelon Behavioral Health
Ryan LoaderRyan Loader
Regional Director at Core & MainRegional Director at Core & Main