Maxwell Adu-Boakye
Worcester,MA
Summary
Provider Network Management 7+ years of experience in a managed care environment related role, such as contracting or provider network services. Provider Auditing and Claim Processing 5+ knowledge of Provider Relation, Claims processing systems and guidelines and provider auditing.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Operations Officer
Maestro Connections Health Systems
07.2022 - Current
- Develop and implement strategic plans to achieve the company's goals and objectives
- Recruits, trains, and manages a competent and efficient workforce
- Maintains policies and procedures related to PHI access and use
- Evaluates and negotiates contracts with Insurance Plans/Companies
- Ensures the smooth and efficient operation of all aspects of the company's activities
- Works with Administrator/Nursing Supervisor on accreditation compliance
- Ensures compliance of federal, state, and local laws and regulations for all offices
- Report on changes in applicable laws and regulations and provides training
- Assists with State surveys, agency evaluations and other regulatory responsibilities
- Works with Administrator on accreditation compliance
Network Provider Contract Manager
Optum Serve, Subsidiary of United Health Group
10.2021 - 06.2022
- Managed performance target setting, performance reporting and associated financial models relative to provider network contracting
- Guided development of geographically competitive, broad access, stable networks that achieve objectives
- Evaluated and negotiated provider contracts in compliance with company templates, reimbursement structure standards and other key process controls
- Ensured that network composition included an appropriate distribution of provider specialty types
- Influenced and/or provided input to forecasting and planning activities for network growth
- Establish and maintain strong business relationships with assigned providers and internal partners
- Research provider footprint and evaluate for gap filling
Network Contract Manager
Fallon Health
10.2013 - 08.2021
- Negotiated, developed and designed contractual provider arrangements including language and pricing methodologies
- Recruited and negotiated contracts with specific providers within operational and potential new counties to meet company requirements
- Ensured provider contracting was consistent with claim payment methodologies
- Maintained familiarity with State Medicaid fee schedules and analyzed comparable Plan pricing guidelines
- Managed, coordinated and resolved operational issues related to specific areas of responsibility
- Served as contact person for internal departments (i.e., Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.)
- Researched, analyzed and presented recommendations to Senior Director regarding contractual and financial decisions
- Managed provider correspondence relating to contracts and responded to requests from potential new providers for FCHP
- Maintained computerized tracking system for new and revised agreements
- Coordinated and communicated contractual information to appropriate departments within FCHP
- Maintained assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Senior Director or Manager
- Prepared updates and maintained files and database for all assigned provider contracts
- Served as committee member in cross-functional teams as assigned by Director
- Responsible for compliance with State and accrediting agencies’ network adequacy standards
- Ensured the provider network meets the health care needs of Plan members
- Establishes a priority list of new geographic locations and types of providers to be added to the Plan network
Personnel Specialist/Administrative Support
United States Navy
02.2007 - 09.2010
- Gained personnel to new commands and prepared personnel for retirement/Fleet Reserve
- Maintained payroll and accounting databases for disbursement and collection of government funds and performed travel claim accounting
- Maintained and audited automated Teller Machines onboard the ships
- Provided pay and entitlement information to individual members
Insurance Officer General Business
Provident Insurance Company
01.2004 - 12.2006
- Maintained a safe, secure and productive environment for employees
- Provided leadership and managed the department, made decisions, solve problems, develop department procedures and represent department at internal and external meeting
- Studied insurance claims, negotiated settlement and approved payments
- Investigated claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company’s liability
- Interviewed medical specialists, agents, witnesses, or claimants to compile information
Education
Master of Healthcare Administration -
Worcester State University
07.2015
Business Administration -
University of Ghana
05.2004
Skills
- Mednet
- MS Office
- QNXT
- EVIPS software
- Cactus Software
- Nextgen
- SOPs
- GDP
- GMP
- CLIA
- FDA
- Operational Efficiency
References
Available Upon Request
Certification
- CompTIA Certification
Timeline
Operations Officer
Maestro Connections Health Systems
07.2022 - Current
Network Provider Contract Manager
Optum Serve, Subsidiary of United Health Group
10.2021 - 06.2022
Network Contract Manager
Fallon Health
10.2013 - 08.2021
Personnel Specialist/Administrative Support
United States Navy
02.2007 - 09.2010
Insurance Officer General Business
Provident Insurance Company
01.2004 - 12.2006
Business Administration -
University of Ghana
- CompTIA Certification
Master of Healthcare Administration -
Worcester State University
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