Michelle Horton
Spring,TX
Summary
Accomplished Senior Provider Contracting Professional with a proven track record in Managed Care , adept in provider contracting and network management in both Commercial and Medicare Advantage networks. Showcasing exceptional problem-solving and teamwork skills.
Overview
32
32
years of professional experience
Work History
Senior Provider Contracting Professional
Humana
04.2007 - 01.2024
- Negotiate and maintain contracts for individual and physician groups, hospital based physicians, small group and ancillary providers.
- Recruited providers as needed to assure attainment of network expansion and adequacy targets for all Commercial ,Medicare lines of business.
- Managed statewide hospital based agreements for Anesthesiology and Pathology groups to remain compliant with TX SB 1742
- Renegotiated existing contracts to achieve compliance with state regulations and updated reimbursement methodologies
- Maintain effective communication with internal teams for support required to achieved successful negotiations ( actuarial modeling, credentialing, contract load and fee schedule management)
- Managed timely updates as needed for maintaining data integrity for physician and ancillary providers.
- Facilitate issue resolution regarding claims, financial recoveries and utilization management.
- Act as a subject matter expert for for new employees regarding systems training, contracting and market dynamics.
Network Account Manager
United Healthcare of Texas, Inc
09.1996 - 03.2007
- Negotiate and maintain individual physician, group and hospital based agreements
- Responsible for new provider orientations and continued education.
- Performed site reviews
- Provider Credentialing
- Investigate and resolve contractual issues regarding claims payment .
- Provide ongoing support of ongoing projects to meet metrics
Discharge Planner
United Healthcare of Texas, Inc
08.1994 - 04.1996
Referral Coordinator
United Healthcare of Texas, Inc
04.1992 - 03.1994
Education
High School Diploma -
Kingwood High School
Kingwood, TXSkills
- Friendly, Positive Attitude
- Teamwork and Collaboration
- Customer Service
- Problem-Solving
Timeline
Senior Provider Contracting Professional
Humana
04.2007 - 01.2024
Network Account Manager
United Healthcare of Texas, Inc
09.1996 - 03.2007
Discharge Planner
United Healthcare of Texas, Inc
08.1994 - 04.1996
Referral Coordinator
United Healthcare of Texas, Inc
04.1992 - 03.1994
High School Diploma -
Kingwood High School