Mark Claiborne
Nashville,TN
Summary
Motivated professional with extensive experience in leadership, project management, and conflict resolution. Detail-oriented, problem solver with exceptional communication skills. Productive in team environments and proficient in achieving company goals. Seeking growth and diversification in career development.
Overview
7
7
years of professional experience
Work History
Provider Engagement Administrator
CareAllies
01.2023 - Current
- Manages value-based agreements between independent physician associations and health plans
- Leads and collaborates with provider engagement team on improving processes, resolving issues, and monitoring contractual achievement
- Conducts monthly physician board of directors meetings, evaluating quality and financial performance
- Maintains strong client relationships with clinicians, clinical staff, and healthcare administration
- Contracts and onboards new physician partnerships to ensure success transitioning to value-based payment models
Provider Engagement Representative
CareAllies
08.2021 - 01.2023
- Prepared monthly quality and financial reporting distributed to partnering practices
- Researched areas of opportunity related to practice performance, and implemented best practices to assist in driving client success
- Developed and maintained positive customer relations through regular onsite meetings with physicians and healthcare staff
- Liaised between health plans and healthcare practices, resolving provider claims, credentialing, and contracting issues
Provider Engagement Specialist
Cigna Medicare
04.2019 - 07.2021
- Assisted Provider Engagement Representatives with monthly physician reporting, and regular physician communication
- Managed provider demographic changes within claims system, internal, and external directories
- Coordinated with internal matrix partners to resolve issues related provider payments, contracting, and claims
Certified Pharmacy Technician
Walgreen's Pharmacy
06.2017 - 04.2019
- Enhanced patient care by accurately filling and dispensing prescriptions in a timely manner.
- Ensured medication safety with thorough verification of prescription orders and drug interactions.
- Maintained accurate inventory levels for efficient pharmacy operations and cost control.
- Collaborated with pharmacists to resolve medication-related issues, optimizing patient outcomes.
Education
Bachelor of Science - Biochemistry
Harding University
Searcy, AR05.2017
Skills
- Operations Support
- Value-Based Contracting
- Medicare/Medicaid
- Financial Data Analytics
- Account Management
- Conflict Resolution
- Insurance Billing
- Strategic Planning
Leadership Roles
- Quality Physician Program Lead
- Peer guide, 2015-2016
- Social Club President, 2016-2017
Timeline
Provider Engagement Administrator
CareAllies
01.2023 - Current
Provider Engagement Representative
CareAllies
08.2021 - 01.2023
Provider Engagement Specialist
Cigna Medicare
04.2019 - 07.2021
Certified Pharmacy Technician
Walgreen's Pharmacy
06.2017 - 04.2019
Bachelor of Science - Biochemistry
Harding University
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