Marina Shepel
Seattle,WA
Summary
Driven and collaborative professional excelling in fostering positive relationships and ensuring compliance within credentialing processes. Adept at navigating complex regulatory landscapes, with focus on delivering meticulous and timely credentialing services. Strong ability to lead and support teams through clear communication, patience, and empathy, ensuring smooth operations and stakeholder satisfaction. Renowned for persuasively negotiating with various parties to achieve optimal outcomes, demonstrating genuine passion for working with people.
Experienced with contract negotiation, ensuring mutually advantageous terms and compliance. Utilizes analytical skills to assess and mitigate risks in agreements. Track record of effective communication and stakeholder engagement.
Overview
20
20
years of professional experience
Work History
Contract Negotiator III
Centene
03.2025 - Current
- Recruit and develop network for a region on and set up providers/clinics.
- Lead assigned recruitments (i.e., physicians, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives.
- Facilitate and oversee the the provider set up and contract configuration to ensure accurate claims adjudication.
- Initiate contract and identify potential providers by geographic and specialty needs and update database.
- Coordinate with internal departments and contracted providers to implement and maintain contract compliance.
- Surpassed contract negotiation goals by 300%, delivering exceptional business outcomes.
- Resolved complex provider issues involving claim non-payments, contract interpretation, reimbursement disputes, and regulatory compliance requirements.
- Managed and resolved complex provider database discrepancies across multiple enterprise systems, ensuring data integrity and operational accuracy.
- Served as a subject matter expert on provider contracts, explaining contract provisions, reimbursement methodologies, and payment terms to providers and internal stakeholders.
- Interpreted and communicated state and federal regulatory requirements, including Medicare and Medicaid guidelines, to ensure compliance and accurate provider reimbursement.
- Investigated and resolved complex payment issues by coordinating across claims, provider relations, contracting, and system support teams.
Analyzed and corrected provider data and contract configuration issues impacting claims adjudication and payment accuracy. - Provided expert guidance on provider reimbursement policies, contract terms, fee schedules, and regulatory requirements, resulting in timely issue resolution and improved provider satisfaction.
Contracting and Credentialing Manager
Eating Recovery Center of Washington
10.2014 - 08.2024
- Initiate and maintain contractual relationships with payers and health plans.
- Responsible for all aspects of credentialing, re-credentialing, and contracting in the following states: WA, CA, CO, IL, OH, TX, and MD.
- Facilitate all payer contracting activities, including contract language review of financial and administrative terms, and strategic positioning under the direction of the VP of Payer Strategy.
- Report financial outcomes of negotiations, and work on annual budgets.
- Initiate and Contract - Group Agreements for Internal Medicine/Family Medicine Practice.
- Initiate and Contract: Group Agreements for Behavioral Health Providers.
- Initiate and Contract - Facility Contracts for Behavioral Health IP, RES, PHP, and IOP Programs in WA, CA, CO, IL, TX, MD, OH, and SC.
- Initiate and execute Single Case Agreements (SCA's) for medical and behavioral programs.
- Lead and initiate interdepartmental credentialing meetings.
- Monitor, analyze, and report on the state of the payor industry via report cards and other assessments.
- Work closely with the Revenue Cycle Management Department to ensure that the company's complex program.
Financial Accounts Support Manager
The Moore Center (acquired by Eating Recovery Center)
04.2006 - 10.2014
- Revenue Cycle Manager, entered daily receipts, posted daily charges, bank deposits
- Prepared and managed financial and statistical records, budgets, forecasts
- Reported findings to the Quality Management Evaluation Committee
- Participated in planning and reviewing meetings with Senior Staff, including policies, procedures and operational quality assurance
- Presented status reports on accounts to CEO
Education
Business Administration -
Easter Washington University
01-2010
Skills
- Contract Negotiation & Management
- Medical and Behavioral Health Contracting
- Provider Relationship Management
- Strategic Planning & Execution
- Financial Reporting & Analysis
- Revenue Cycle Management
- Cross-functional Team Leadership
- Project Coordination & Management
- Credentialing & Compliance
- Budgeting & Forecasting
- Healthcare Networks & Payer Strategy
- Proficiency in Microsoft Excel
- Proficiency in Microsoft Word
- Proficiency in Microsoft PowerPoint
- Strategic negotiation
- Persuasion techniques
- Building rapport
- Teamwork
- Problem-solving
- Teamwork and collaboration
LANGUAGES
Russian - Bilingual
Ukrainian - Fluent
Timeline
Contract Negotiator III
Centene
03.2025 - Current
Contracting and Credentialing Manager
Eating Recovery Center of Washington
10.2014 - 08.2024
Financial Accounts Support Manager
The Moore Center (acquired by Eating Recovery Center)
04.2006 - 10.2014
Business Administration -
Easter Washington University