Novella Reed-Miles
El Camino College Community Education
Fontana,CA
1
Certification
21
years of professional experience
To secure a rewarding and challenging career with a stable organization that will benefit from my experience, strong work ethic, organizational skills, and ability to communicate and work well with others.
Work History
Lead Director, Network Management
20 Years 3 Months- Negotiate, renegotiate, and execute physician, provider, group, and facility medical and behavioral health contracts in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality, and financial goals.
- Accountable for all aspects of physician, group, and facility recruitment and contracting, as well as ad hoc network contracting, as assigned.
- Developed and maintained network strategies to enhance cross-market network management units.
- Participate in the strategic recruitment of physicians, groups, and facilities satisfying specific network goals and objectives.
- Trained department employees on critical subject matter to ensure success in their roles.
- Interface with Claims, Case Management, Quality Management, Market Heads, and Senior leadership.
- Selected for the Monday Morning Leadership training (2012)
- Selected for the Blue Circle Leadership program (2016-2017)
- Selected for the Project Management Program (2018-2019)
- Member of Behavioral Health Employee Engagement Team (2009-2013, 2015-2019)
- Network Employee Engagement Team Lead (2010, 2011, 2012, 2013, 2017, 2019)
Manager of Network Management
4 Months- Manage Behavioral Health Contracting, Provider Relations, and Credentialing Departments.
- Ensure that the Provider Network is fully contracted and credentialed by the Health plans to accommodate Member demographics.
- Ensured full contracting and credentialing of provider network by health plans to meet member demographics.
- Maintained database integrity for provider information, rates, and credentialing information.
- Responsible for Network Management system upgrade.
- Executed the upgrade process for the Network Management system.
- Interface with Claim, Case Management, Quality Management, and Information Technology Departments both internally and contracted Health Plans.
- Executed projects assigned by the President.
Medical Billing & Coding Instructor
10 Years 11 Months- Instructed students on CPT, ICD10, HCPCS, and HIPAA, including abbreviations, anatomy, physiology, medical terminology, front procedures, appointment setting, and Medi-Soft billing software.
- Developed curriculum for medical billing and coding courses to enhance student engagement and learning outcomes.
- Evaluated student performance through assessments, providing constructive feedback to foster skill development.
- Collaborated with industry professionals to keep course materials current with evolving regulations and technologies.
- Evaluated student progress regularly through assessments, adjusting teaching strategies as needed to address areas of weakness or confusion.
- Managed classroom effectively; addressing any behavioral issues promptly while maintaining focus on academic goals.
- Awarded Teacher of the Year - 2016 and 2020
Education
Career Training Education Teaching Credential
- Commission of Teaching Credentialing: Completed December 2016
- Social and Emotional Distance Learning: Completed September 2020
- Career Technical Education Teaching Credential (6/10/2021 – 7/1/2031)
Master’s - Business Administration
- Inducted into Whitehead Leadership Society
- Dean's List
- 3.7 GPA
Bachelor’s - Business Administration
- 3.7 GPA
- Magna Cum Laude graduate
Affiliations
- University of Redlands
- Whitehead Leadership Society - Board Member
- 2023-2025
Certification
National Healthcareer Association
- Certified Billing & Coding Specialist
- Certification # Q6K3E8N4 (6/9/2017-6/9/2027)
American Health Information Management Association
- Certified Coding Associate (CCA)
- Certification # 218379 (4/17/2018-7/16/2020)
Timeline
Medical Billing & Coding Instructor
El Camino College Community Education
09.2015 - CurrentRead More
Lead Director, Network Management
Aetna Health (CVS Health)
05.2006 - CurrentRead More
Manager of Network Management
College Health IPA
01.2006 - 05.2006Read More
University of San Diego
Career Training Education Teaching Credential
Read More
University of Redlands
Master’s from Business Administration
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University of Redlands
Bachelor’s from Business Administration
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