Mia Silas
Coral Springs,FL
Summary
Accomplished Provider Network Manager Sr at Simply Healthcare Plans, adept in provider contract negotiations and relationship development. Leveraged SalesForce, account relationships and strong mentorship abilities to enhance network performance and compliance, achieving a robust network. Excelled in strategic collaborations, significantly impacting healthcare delivery and patient growth.
Overview
20
20
years of professional experience
Work History
Provider Network Manager Sr
Simply Healthcare Plans
08.2023 - Current
- Provider contract negotiations, relationship development and servicing of contracted Hospital Employed Physician Groups
- Monitor utilization performance to determine appropriate Physician Incentive Programs and other Plan opportunities
- Attend monthly and bi-weekly touch point meetings with assigned Groups
- Communication link between assigned contracted Organizations and Health Plan
- Serve as key resource for other contracting staff and internal partners
- Mentor and provide on-the-job training and development of peers
- Conduct complex negotiations and draft documents
- Schedule and host monthly JOC meetings
- Prepare financial projections and conduct analysis of utilization performance
- Ensure that network composition includes an appropriate distribution of provider specialties
- Work on projects requiring collaboration with key areas
- Serve on enterprise projects around network management and Compliance Department for regulatory contracts
Director, Business & Network Development
Foundation for Sickle Disease Research and Academy of Neurosurgical Physicians
06.2022 - 06.2023
- Initiated and negotiated Health Plan contracts for FSCDR and ANP
- Key Manager of Statewide satellite site expansion for FSCDR
- Visited satellite areas to engage Community Based Organizations, Faith Based Organizations, Hospitals and Local Physicians to drive patient growth
- Liaison for State Grant Deliverables
- Negotiated payments for Letters of Protection (LOPs) with Law Firms for Personal Injury Protection Cases (ANP)
- Provided Credentialing, State and Regulatory License guidance and support
- Health Plan / Payor liaison for internal staff and Providers
- Monitored and reviewed patient growth, utilization and HEDIS reports
Business Development Manager
AssociatesMD and Physicians Plus MSO
09.2020 - 06.2022
- Contracted Physician and Group practices for MSO and Contracted Plans for ACA, Medicare Advantage, Medicare DCE (Direct Contracting Entity) and ACO Reach
- Key service contact for contracted Providers, Groups, internal staff
- Built robust MSO of over 200 Provider / Group agreements within one year
- Developed internal processes for Contractors and Service Representatives
- Provided support to internal Contractors and Service Representatives
- Established, updated and maintained contract inventory file
- Participant of Value-Base Care Committee
- Communicated Provider issues to internal Upper Management and Health Plans
- Pursued Physician practice acquisitions
Provider Network Manager
Simply Healthcare Plans
04.2013 - 09.2020
- Contracted and Serviced Providers in HIV/AIDS Specialty Plan, MMA Medicaid, Medicare Advantage products, Florida Healthy Kids, MediKids for value-based and non-risk contracts
- Built robust PCP and Specialty network for Clear Health Alliance
- Engaged Physicians and Practice Administrators monthly to discuss growth, opportunities, performance and utilization
- Provided HEDIS and MRA support
- Scheduled and attended JOC (Joint Operating Committee) Meetings
- Conducted in-service and MOC (model of care) presentations to Practice Staff and Physicians
Provider Relations Specialist
Sunshine State Health Plan
01.2005 - 04.2013
- Began employment with PhyTrust of Florida, a start-up MSO (later became Sunshine State Health Plan, a Centene Company)
- Contracted and serviced Providers
- Reviewed and shared monthly utilization reports with Providers
- Drove growth and opportunities by engaging prospective Providers
- Once acquired by Centene, re-contracted existing Providers for Sunshine State Health Plan Medicaid participation
- Provided support to full and no risk contracted PCPs
- Provided training for claims, authorizations, Plan portal and EDI
- Plan representative for community events, galas and quarterly Provider educational dinners
Skills
- SalesForce
- NextGen
- InterAct
- PLM-2/SPS
- MACESS
- CRM
- Emptoris
- CACTUS
- Facets
- QNXT
- E-Clinical Workx
- OneNote
- OnDemand
- Practice Fusion
- MicroSoft Office
- AVAILITY
- BI Reports
- PEGA Applications
Timeline
Provider Network Manager Sr
Simply Healthcare Plans
08.2023 - Current
Director, Business & Network Development
Foundation for Sickle Disease Research and Academy of Neurosurgical Physicians
06.2022 - 06.2023
Business Development Manager
AssociatesMD and Physicians Plus MSO
09.2020 - 06.2022
Provider Network Manager
Simply Healthcare Plans
04.2013 - 09.2020
Provider Relations Specialist
Sunshine State Health Plan
01.2005 - 04.2013
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