Summary
Overview
Skills
Work History
Education
Timeline
Generic

Rebecca Cyree

Payer and Provider Contracting
Burbank,CA

Summary

Healthcare professional with 18 years in payer & provider contracting, provider network operations, contract lifecycle management and performance improvement. Extensive experience in contract analysis, draft language, document review and implementation, including cross-functional collaboration with operational teams to support contract compliance. Dedicated to creating positive relationships through transparency, mutual respect and collaboration.

Overview

18
18

Years of Industry experience

Skills

  • Contract Negotiation
  • Provider Network Management
  • Contract Lifecycle Management
  • Managed Care Operations
  • Value Based Contracting
  • Relationship Management
  • Regulatory Compliance
  • Policy Development and Training
  • Process Improvement

Work History

Heath Plan Contracting Manager

MedPOINT Management
Los Angeles, CA
07.2022 - 05.2023
  • Technical contract expert for MedPOINT's Health Plan Contracting team
  • Reviewed, analyzed and redlined health plan contract proposals, including delegated responsibilities and related incentive terms, and in conjunction with information contained in health plan provider manuals
  • Summarized and distributed contract updates for internal review and approval prior to finalizing new or amended agreements
  • Facilitated biweekly meetings with health plans to identify and remediate roadblocks related to stalled negotiations
  • Closed 56% of open negotiations in first six months
  • Prepared and presented monthly health plan negotiation summaries for IPA/Medical Group client board meetings
  • Met with client representatives prior to each board meeting, prospectively addressing questions or concerns regarding current negotiations, proposed material terms and anticipated impact of new amendments and agreements
  • Created standardized template for communication of contract terms, including clear identification of changes to Divisions of Financial Responsibility (DOFR), reimbursement methodologies, incentives, penalties and recoveries
  • Analyzed new laws and regulations to identify required changes and proactively adjust systems
  • Developed departmental policies and procedures to minimize regulatory risks and liability

Senior Network Development Consultant

EWINGS, INC
National Contractor
01.2022 - 04.2022
  • Senior negotiator for client build of adequate and sellable networks in new markets
  • Engaged roughly 800 assigned independent practitioners, physician groups and ancillary providers to support client's Virginia expansion
  • Documented all contracting activities in Quickbase
  • Executed client provider contracting strategy utilizing client's templates and scripts, enforcing contract standardization
  • Collaborated with client's internal team members and EWINGS consultants to ensure timely network build and accurate implementation
  • Created pricing tools and customized Quickbase report templates to mitigate duplicate outreach
  • Applied effective time management techniques to meet tight deadlines

Senior Manager, Provider Contracting

Blue Shield of California Promise Health Plan
Monterey Park, CA
03.2020 - 08.2021
  • Managed contracting team for BSC Promise's direct network, including ancillary, specialist, behavioral health, social services contracts, and single case agreements
  • Primary driver for ancillary Medi-Cal LOB network expansion, cost of healthcare initiatives, contract implementation and oversight; resolved configuration errors for dialysis providers, leading to $40M in recoveries
  • Connected with individual staff on weekly basis to monitor performance and morale, customized workloads to prevent burnout
  • Responsible for departmental policy development and documentation, budgeting, target setting and weekly KPI reporting
  • Performed compliance review of new and amended contracts within contract management system; approved or rejected, as appropriate
  • Reviewed government healthcare policies and regulations, identified impact to contracting and collaborated with internal departments to initiate necessary system updates and create/revise internal policies or manuals
  • Developed proposals and presentations for internal and external audiences
  • Conducted performance evaluations, compensation reviews and hiring to maintain departmental staffing requirements

Manager, Managed Care

Cedars Sinai Medical Network
Los Angeles, CA
07.2017 - 07.2019
  • Manager of newly formed Managed Care team; responsible for day to day Contracting operations, trouble-shooting new Tapestry (Epic EMR) Managed Care workflows, and maintaining SB 137-compliant IPA and Medical Group provider data
  • Owned processes related to provider data accuracy at plan level and within Cedars-Sinai's multiple internal systems
  • Participated in development of annual budget and established departmental goals in alignment with enterprise objectives
  • Collaborated with executive leadership, physicians, service line administrators and operational departments in development and implementation of new managed care strategies
  • Devised and monitored cross-functional CRM queues for contracting, finance, network operations and managed care departments
  • Boosted team member productivity by implementing daily management system, enhancing performance monitoring and instituting motivational approaches
  • Reduced volume of HMO claim pends by 87% per check run by troubleshooting critical Tapestry and Peoplesoft system integration issues
  • Revised onboarding process for new contracts, decreasing average TAT for provider data submission to health plans by 40%
  • Achieved 34% reduction in TAT for CRM tasks and inquiries assigned to contracting and managed care staff
  • Employed structured change management strategies to improve effectiveness of revised contracting processes

Project Manager, Managed Care

Cedars Sinai Medical Network
Los Angeles, CA
02.2015 - 06.2017
  • Identified problems with contracting department's current state operations and implemented remediation plans, documenting business requirements, standardized training and process guidelines
  • Authored Cedars-Sinai Medical Network's Contracting Operations manual; introduced newly documented requirements via 8-session retraining of contracting department
  • Continued to act as business operations lead for managed care systems, testing contract build for third-party administrator's migration to Tapestry while also working with EIS on initial phases of Cedars-Sinai Health System's Tapestry implementation
  • Outlined work plans, determined resources, defined timelines, and generated initial budgets for departmental improvement projects
  • Hired and managed temporary staff to support team projects
  • Adjusted project assignments and schedules to keep pace with dynamic business needs, factoring in employee knowledge and client demands
  • Monitored contracts and service level agreements to identify potential risks and implement mitigation actions to protect development process from unforeseen delays and cost
  • Engaged wide range of stakeholders, conveying business needs to technical teams and presenting analysis and recommendations to executive leadership

Supervisor, Contract Operations

Cedars Sinai Medical Network
Los Angeles, CA
07.2013 - 01.2015
  • Created Cedars-Sinai Health Associates (IPA) & Cedars-Sinai Medical Group HMO contract database for over 300 active fee-for-service and capitated managed care contracts
  • Co-created HMO Claims Examiner Training Guide tool utilized by staff in six departments
  • Performed contract build testing for Cedars-Sinai health system's migration to Epic EHR professional billing
  • Developed or updated contracting department operating procedures, contract templates and intake form
  • Documented cross-functional workflows for managed care, created interdepartmental training tools and process guidelines for managers of each team
  • Defined operational metrics to evaluate efficiency of managed care processes and procedures; worked with decision support to develop associated reports
  • Provided direct oversight for implementation, re-papering, or termination of legacy agreements for newly acquired physician groups
  • Led cross-functional work group focused on identification and resolution of gaps in contract implementation and provider onboarding
  • Monitored employee performance, provided coaching and constructive guidance to address areas of concern

Contract Specialist

Cedars Sinai Medical Network
Los Angeles, CA
07.2005 - 06.2013
  • Negotiated optimal contract terms and conditions for IPA and Medical Group, minimizing downstream risk and maximizing financial objectives
  • Collaborated with utilization management leadership and decision support to create internal provider database, reducing out of network referrals and capitation leakage by 25% in first year
  • Audited bi-weekly check runs to ensure claims were processed per correct fee schedules and DOFR rules
  • Monitored and evaluated contract performance to determine regulatory compliance and necessary amendments
  • Maintained IPA and medical group division of financial responsibility matrix (DOFR), pharmacy risk tool, digital and paper contract files, and ensured compliance with regulatory mandates and company policies
  • Contract operations lead for 3rd party vendor's HMO system migration to MC400, performed testing and validation of > 500 contracts
  • Negotiated approximately 600 letters of agreement and 350 new or amended contracts over six years
  • Communicated contract terms to medical management, claims and information systems departments
  • Monitored accuracy and timeliness of configuration changes pertaining to new or amended contracts
  • Assisted internal departments with questions regarding Division of Financial Responsibility (DOFR)
  • Tracked contract termination dates and coordinated with director to initiate contract renewals and re-negotiation requests
  • Consulted with director of contracting and legal affairs team in review of escalated claims disputes

Education

Diploma -

Palm Bay High School

Eastern Florida State College
Cocoa, FL

Timeline

Heath Plan Contracting Manager

MedPOINT Management
07.2022 - 05.2023

Senior Network Development Consultant

EWINGS, INC
01.2022 - 04.2022

Senior Manager, Provider Contracting

Blue Shield of California Promise Health Plan
03.2020 - 08.2021

Manager, Managed Care

Cedars Sinai Medical Network
07.2017 - 07.2019

Project Manager, Managed Care

Cedars Sinai Medical Network
02.2015 - 06.2017

Supervisor, Contract Operations

Cedars Sinai Medical Network
07.2013 - 01.2015

Contract Specialist

Cedars Sinai Medical Network
07.2005 - 06.2013

Diploma -

Palm Bay High School

Eastern Florida State College

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