Open To Work
Natalie Clark
Charlevoix,MI
Summary
Collaborative leader and analytical problem-solver with over 13 years of provider contracting and network operations experience, skilled in leveraging data-driven insights, developing and optimizing processes, guiding teams, managing complex projects and driving strategic initiatives.
Recognized for adaptability to quickly identify and resolve operational issues with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals.
Overview
25
25
years of professional experience
Work History
Provider Engagement Associate Director
HUMANA
01.2023 - Current
- Managing KY, WV and MI markets network operations team of 30+ associates and over 100 Value Based Contracts partner with Contracting and Provider engagement teams to support new requests to join process, KY, IN, OH and MI Medicaid and Value Based Contracts implementations, as well as ongoing provider contracts data audits and updates including major contract terminations.
- Experienced in implementation of Medicaid new networks in Midwest region’s markets KY, OH, IN, MI in partnership with Contracting and Medicaid teams; onboarding, hiring, training Medicaid focused associates and developing end to end provider contract load, end and membership enrollment efficiencies to support contracting network operations.
- Partnered with core teams to support MI Medicaid early network built stages, including developing, testing and implemented MI Provider Portal, created intake process flow for requests to join new contracts (2024 - Q1 2025). Partnering with Midwest Contracting, Medicaid Ops teams, Provider Engagement to implement end to end strategy for new complex IDS, ACO and RHC/FQHC value based deals including corporate accounts Agilon, Aledade, Centene/Wellcare and Oak Street Health for both Medicare and Medicaid. Received STAR Awards 2023-2024 for operational excellence and successful completion of Baptist Health MG Major End to end new Baptist Contract load execution.
- Collaborative and process-improvement and results-oriented leader with in-depth knowledge and experience of all Midwest Region’s markets and key provider groups (IN, OH, MI, KY and WV) with 9 years of progressive leadership experience within Network Operations Management/Contracting organization, partnered closely with Provider Engagement, Contracting and Market Finance to implement large cross-functional strategic initiatives and provider contracts data management tools and processes resulting in improved provider data accuracy, optimized value based contracts performance and Medicare membership growth through operational improvements, key VB provider end to end data audits, new Medicare/Medicaid products expansions long-term positive relations with Midwest region’s providers
Senior Network Operations Professional (Process Lead)
HUMANA
01.2017 - 01.2023
- Received multiple STAR Awards in 2019, 2020, 2022 for improving regional contracting and network operations provider data management and load processes and streamlining 150+value based physician and FQHC/RHC contract load implementations across multiple Humana systems, positively impacting provider/member experience in OH, IN, MI markets.
- Key network operations projects completed: 1) Humana standard roster template (Physician and RHC/FQHC), 2) Midwest Physician and RHC/FQHC Specifics templates to support new contract load process; 3) provider contract data audits (PD Audit 1.1 tool), 4) requests to join Humana’s network (RTJN) market triage process, 5) value-based senior group strategy and contract load implementations processes, 6) Humana provider directories accuracy, 7) new NOC onboarding training, 8) new OH Medicaid load guidelines and processes development and training (Physician, Facility/RHC/FQHC), OH Medicaid provider contract data load audit prior go live 2/1/23.
- Managed market network operations for new processes development, OH Medicaid roster template, OH Medicaid ID verification, OH Medicaid terms and member notification letters, OH Medicaid Service Fund group audits and OH Medicaid RHC/FQHC loading guidelines and associate training to prepare for OH Medicaid go live 2/1/2023.
- Supported large provider contract implementations for key health systems and RHC/FQHCs in OH, IN, MI markets such as: Beaumont ACO (MI), Affinia (MI), Henry Ford Health System (MI), United Physicians (MI), Cleveland Clinic (OH), Ohio Health (OH), OSU (OH), St Elizabeth HS (OH/KY), Mercy Health (OH), Parkview (IN), CCNI Franciscan ACO (IN) and corporate contracts: Aledade (MI), Agilon (OH), Dedicated (MI/OH) Oak Street Health (IN, OH, MI).
- Collaborated with market Finance, Provider Engagement, PNO and Service Fund teams to design and execute regional path to value contract load process (MP, MP w/SS, Risk) to manage new value contracts load work, rolled out to other markets.
- Developed and managed the first Service Fund value based provider group data audit process for the Midwest region impacting all key value based provider contracts; trained and lead a group of 4 NOCs to conduct Service Fund group audits resulting in over 450 APEX work cases submitted to fix PCP provider data discrepancies.
- Served as market SME in developing and testing the standardized Humana Provider Roster Template, worked with key provider groups to collect initial feedback, promoted adoption Humana-wide on 2 ‘early adoption’ regions.
- Co-managed new provider data audit tool development (Green Belt project) which enabled NOCs and Contractors Humana-wide to significantly reduce roster data audit analysis time. The new audit tool allowed NOCs to conduct provider contract data review against the contract and quickly identify provider data load issues/submitt corrections to fix/prevent claims issues.
- Received STAR Awards 2023-2024 for operational excellence and successful completion of Baptist Health MG Major End to end new Baptist Contract load execution.
Medical Billing Auditor
PRIME HOMECARE LLC
Cincinnati, OH
01.2016 - 01.2017
- Managed provider contracts with major payers in Ohio/NKY region to ensure in-network placement and reimbursement pricing for Occupational, Physical, Speech Therapy and Home Health services; served as a certified Cultural Competency trainer.
- Lead internal billing audit reviews, managed process improvement initiatives to resolve critical billing issues within required time lines. Redesigned internal audit review processes to improve efficiency and ensure compliance with CMS and COA requirements for data accuracy and completeness.
Senior Medical Interpreter
VOCALINK LANGUAGE SERVICES
Cincinnati, OH
01.2013 - 01.2016
- Provided qualified medical interpreting services to all major hospital networks and large provider groups within Cincinnati Northern Kentucky and Dayton area. Fostered cultural competency and enabled effective communication between healthcare providers and limited English Proficiency (LEP) patients; Received Cultural Competency Trainer certification.
- Lead new associate onboarding training and provided one on one coaching for new medical interpreters.
Senior Contracts Development Professional
ELI LILLY AND COMPANY
Indianapolis, IN
01.2008 - 01.2012
- Lead cost/benefit evaluations and terms/conditions reviews for new contract offers; presented new contracting opportunities to senior leadership to ensure market access for 12 pharmaceutical brand products in 4 market segments. Performed contract management tasks and customer issue resolution; conducted periodic audits and product performance reviews to ensure overall post-deal contract compliance and profitability. Completed contract renewals, amendments and final close-outs; developed and executed long-term contract strategy plans.
- Managed entire contracting process from the initial proposal evaluation to final contract close-out for over 100 Commercial and State Medicaid accounts with total annual sales of $850M; delivered customer-focused solutions while ensuring data integrity within various financial systems.
- Effectively lead the post-patent contracting process for Lilly top blockbuster neuroscience product and achieved $50M in additional net contracted sales at the largest Medicaid account by streamlining documentation review and decision making process to meet demanding customer time-lines.
- Delivered $1.7M savings as discount reduction by implementing company first class-of-trade contract audits in Long Term Care segment to ensure member discount eligibility, while effectively resolving customer issues and managing up communication process with Legal and Senior Leadership.
- Increased Medicaid segment annual net sales by 20% by working diligently with customers and cross-functional teams to create and implement a new Medicaid buying pools contracting strategy which allowed organization to negotiate new multi-year contracts with the largest Medicaid customers.
- Improved proposal review decision making and contract status tracking and reporting productivity by 25% for a team of 16 Contract Development Analysts by implementing a web-based Contract Status Tracker.
- Gained $7M in rebate savings by challenging the existing brand strategy for Long Term Care segment and by proposing alternative strategy direction based on key changes in marketplace regulations and in-depth products’ financial performance analysis; completed renewal negotiations with 4 impacted customers.
- Created and implemented a new contract/customer on-boarding process, resulting in enhanced brand equity with State Medicaid and Commercial customers based on the industry-wide Voice of the Customer survey; ensured early detection, prevention and significant reduction of contract administration issues.
Senior Financial Analyst
ELI LILLY AND COMPANY
Indianapolis, IN
01.2005 - 01.2008
- Managed financial SAP master data set-up and issues resolution affecting inter-company sales and distribution processes for 13 Lilly global affiliates. Created standard operating procedures and lead global power user trainings. Performed financial data audits to ensure SOPs compliance. Increased compliance rate with financial master data standards among 300 power users and reduced the number of data-related issues by 50% by creating a web-based financial master data protocols library.
Information Analyst
ELI LILLY AND COMPANY
Indianapolis, IN
01.2003 - 01.2005
- Developed and implemented commercial phase clinical trials for Lilly pharmaceutical brand products. Managed tight deadlines for designing systems solutions within designated clinical trials data management tools. Received Regional Quality IT Award 2005
Business Integrator
ELI LILLY AND COMPANY
Indianapolis, IN
01.2001 - 01.2003
- Managed multiple sales force alignment projects and resolved data issues on the Demand and Realization IT team to achieve successful positioning of US and Puerto Rico sales forces for five new product launches.
- Performed physician and prescription trend analysis and implemented sales force realignment data changes.
- Created, tested and delivered over 200 sales force alignment and realignment technical solutions to prepare Lilly sales force for new brand product launches; successfully coordinated new alignment system roll-outs across HR, Manufacturing, Finance, Sales and Marketing organizations.
- Lead system requirements gathering and testing for the first global Market Research studies repository project, implementing it with 0% defects, ahead of schedule; received IT Solution Achievement Award.
Education
MBA - Marketing
Indiana University, Kelley School of Business
Indianapolis, INBA - Business Administration
Taylor University
Upland, INBA - French Education
State Teachers University
RussiaSkills
- Midwest Region Provider Contracting
- Key relationship development
- Network Management/Leadership
- Medicaid Provider Contracting
- Value Based Contract Implementations
- Provider Data Management and Audits
- People Leadership
- Project Management
- Process Improvement
- Lean/Six Sigma
- Project management
- Strategic leadership
- Coaching and mentoring
- Team collaboration and leadership
- Operations management
- Onboarding and training
- Budget management
- Hiring and training
- Analytical thinking
- Relationship building
- Organizational development
- Stakeholder engagement
- Regulatory compliance
- Program coordination
- Contract negotiation
- Contract management
- Data analysis
- Staff management
- Team leadership
- Project planning
- Employee coaching and mentoring
Accomplishments
- Supervised team of [Number] staff members.
- Reduced [Adverse effect] by [Number]% through [Action taken].
- Achieved [Result] through effectively helping with [Task].
- Collaborated with team of [Number] in the development of [Project name].
Work Preference
Job Search Status
Open to workSalary Range
$90000/yr - $200000/yrTimeline
Provider Engagement Associate Director
HUMANA
01.2023 - Current
Senior Network Operations Professional (Process Lead)
HUMANA
01.2017 - 01.2023
Medical Billing Auditor
PRIME HOMECARE LLC
01.2016 - 01.2017
Senior Medical Interpreter
VOCALINK LANGUAGE SERVICES
01.2013 - 01.2016
Senior Contracts Development Professional
ELI LILLY AND COMPANY
01.2008 - 01.2012
Senior Financial Analyst
ELI LILLY AND COMPANY
01.2005 - 01.2008
Information Analyst
ELI LILLY AND COMPANY
01.2003 - 01.2005
Business Integrator
ELI LILLY AND COMPANY
01.2001 - 01.2003
BA - Business Administration
Taylor University
BA - French Education
State Teachers University
MBA - Marketing
Indiana University, Kelley School of Business
Additional Training
- Value-based Sales and Negotiations Workshop
- Lean and Six Sigma Training
- “Executive Technique” Public Speaking Workshop
- Project Management Professional
- Stephen Covey: “4 Disciplines of Execution”
- The Community Medical Interpreting (TCI)