Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nydia Krystofiak

Pell City

Summary

Knowledgeable and dedicated contracting professional with extensive experience. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with hospitals, provider offices and ancillary facilities. Motivated to maintain Humana standard and contribute to company success.

Overview

18
18
years of professional experience

Work History

Provider Contracting Executive

Humana, Gulf South
11.2020 - Current
  • Oversee and administer Hospital and Provider contractual agreements, ensuring compliance and accuracy. Negotiate rate terms that are advantageous to both Humana and participating Hospitals/Providers. Organize and facilitate both internal and external meetings to support contract management processes. Evaluate and address requests for language modifications from Hospitals and Providers utilizing the NLRG tool and other approved internal resources.

Provider Contracting Professional II

Humana, Tampa, FL
01.2017 - 01.2020
  • Negotiate, renegotiate and manage contracts for Ancillary providers in North and Central Florida counties. Assist provider groups with all contract related issues and concerns including, but not limited to, credentialing, claims and directories. Schedule and host monthly JOC meetings with provider’s to address and resolve outstanding issues with satisfactory outcomes. Maintain good working relationships internally and externally. Collaborate internally to ensure equitable outcomes from contract negotiations for all parties involved. Work with various internal departments and provider groups to close gaps for Medicaid and ensure network adequacy. Serve as trainer for new associates to educate them on systems and business acumen. Assist team members as needed when manager is out of office.

Large and Ancillary Contract Executive

Humana, Louisville, KY
01.2015 - 01.2017
  • Negotiate and renegotiate contracts for Physicians, Physician groups, and Hospital systems. Schedule and host monthly provider meetings to resolve issues and maintain good working relationships. Meet with provider groups on a quarterly basis face to face. Work internally with other departments to provide resolution of contract related issues. Responsible for the renegotiation of one of the largest hospital systems in the market to obtain lower rates and add additional networks to meet adequacy. Serve as subject matter expert for various Humana based systems.

Network Specialist/Physician Contracting Representative

Humana, Louisville, KY
01.2010 - 01.2015
  • Create and execute contracts for Durable Medical Equipment and Orthotics and Prosthetics specialties using payor specific systems. Create and send letters to providers in response to contracting requests for participation. Evaluate the need and negotiate contracts for providers with regards to adequacy. Create, send and execute contracts and amendments for new and existing networks. Work directly with National providers to ensure accuracy of information submitted and loaded. Assist Market Management team and Provider Concierge Unit in analyzing and correcting root cause of any contract load/claims payment errors. Work closely with contractor to ensure network adequacy for all networks. Attend and schedule meetings with other Humana associates and National providers to assist with issue resolution. Third place winner of PIP project designed to reduce out of network spend for Durable Medical Equipment. Analyze and identify root cause of provider complaints related to claims and contract loads using various systems. Attend calls on a weekly basis with Market Management Consultants.

Clinical Intake Specialist

Humana, Louisville, KY
03.2010 - 09.2010
  • Assist Providers with authorizations and referrals. Assist providers with questions pertaining to pending authorizations and transfer to Clinical Intake Nurse when necessary. Provide outstanding customer service. Work with Internal and External Business partners while maintaining confidentiality. Proficient use of all job related systems and functions.

Contract Load Specialist

Humana, Louisville, KY
01.2008 - 01.2010
  • Create and edit Excel spreadsheets, scan and input contracts for loading, place follow up calls to facilities for contracting purposes. Perform data entry, scanning, faxing, and copying on a daily basis. Mail and email contracts to providers as requested and ensure all paperwork is in order before sending out. Ensure all paperwork received is complete before putting in required systems for loading. Update information in Humana specified systems to maintain accurate account of contracted providers. Assist contractors with any requested functions. Research various systems in order to update Excel spreadsheets, database, and other systems. Use various work specific systems to verify and update information. Considered the subject matter expert for systems and tools related to provider loads.

Education

Associate of Science Degree - Business Management

Mid-Continent University
Mayfield, KY

Skills

  • Interpersonal skills
  • Operations management
  • Customer-oriented
  • Problem resolution
  • Team player
  • Client account management
  • Research and analysis
  • Customer retention
  • Account management

Timeline

Provider Contracting Executive

Humana, Gulf South
11.2020 - Current

Provider Contracting Professional II

Humana, Tampa, FL
01.2017 - 01.2020

Large and Ancillary Contract Executive

Humana, Louisville, KY
01.2015 - 01.2017

Clinical Intake Specialist

Humana, Louisville, KY
03.2010 - 09.2010

Network Specialist/Physician Contracting Representative

Humana, Louisville, KY
01.2010 - 01.2015

Contract Load Specialist

Humana, Louisville, KY
01.2008 - 01.2010

Associate of Science Degree - Business Management

Mid-Continent University

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