Ricky Crumpton
Dallas,TX
Summary
Physician Business Manager with 9+ years of experience in healthcare management, specializing in developing and maintaining high-quality provider networks. Expertise in strategic planning, project management, and cross-functional collaboration.
Overview
9
9
years of professional experience
Work History
Physician Business Manager
WellMed Medical Management Optum Care Delivery
04.2023 - Current
- Manage physician operations, optimize resource allocation, enhance patient care, and drive measurable improvements in clinical outcomes
- Lead medical practice initiatives, streamline workflows, improve efficiency, and foster a culture of continuous improvement within the team
- Coordinate with healthcare professionals to align business strategies, ensure seamless operations, and promote a patient-first approach
- Oversee performance metrics, implement data-driven strategies, and achieve significant operational effectiveness and advancements in patient satisfaction
- Monitor compliance, maintain meticulous records, and ensure adherence to healthcare regulations while enhancing operational precision and accuracy
- Lead strategic planning and tools for provider success, ensuring they meet quality, risk adjustment, and cost goals
- Conduct detailed analysis of reports to develop strategic plans, ensuring performance goals were achieved
- Educate providers on the WellMed Model of Care, contractual obligations, and best practices of patient care
- Participate in creating and executing a local network development plan to assure network adequacy
- Foster strong relationships with cross-functional teams and external partners to support provider education and network development initiatives
- Collaborate with the Medical Director to analyze utilization trends, boosting efficiency and sharing insights with PCPs for improved patient outcomes
- Led engagement initiatives with external providers, ensuring optimal network use and education
- Drove the adoption of point-of-care technology, empowering providers with tools to improve patient care and achieve better health outcomes
- Streamlined provider engagement processes, leading to enhanced network efficiency and better service delivery
- Facilitated cross-functional team efforts, driving successful adoption of healthcare interoperability initiatives
- Analyzed and presented practice data to executives, boosting tool utilization and fostering collaborative decision-making
- Directed high-profile projects, ensuring successful and timely healthcare solutions implementation through effective stakeholder coordination.
Provider Network Engagement Manager
United Healthcare
11.2021 - 04.2023
- Conduct new provider orientations and ongoing education for providers and their staff on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
- Collaborate with the contracting team to ensure provider data is correct and provider directories include any needed updates
- Represent WellMed/UHG by holding company-sponsored provider events (summits and learning sessions)
- Regularly meet with cross-functional teams to create, revise, and adjust strategies for assigned provider groups to meet overall performance goals.
Associate Business Analyst
OptumRx Inc.
07.2019 - 11.2021
- Escalated issues to appropriate operational departments as needed and informed the Client Services Director of reoccurring service issues, providing resolution suggestions when available
- Provided ticket submission support to upstream and downstream partners for new and existing client benefit information
- Collaborated and communicate with project teams and internal business partners as needed during the ticket submission process
- Maintained up-to-date knowledge of product and service changes
- Ability to work efficiently in multiple systems, including RxCCR, RxClaim, RxComet and ServiceNow.
Senior Pharmacy Prior Authorization/Appeals Technician
OptumRx Inc.
05.2016 - 07.2019
- Managed and monitored multiple Performance Guarantee Clients, Medicare, Medicaid, and Commercial Plans
- Assisted with the ORCA Project Management and Development to align Legacy Catamaran and Legacy Optum
- Ability to effectively present information and engage groups of Associates, Managers, and Clients
- Subject Material Expert (SME) for the Prior Authorization department with resolving any questions technicians may have for processing prior authorizations requests
- Optimized data entry processes, ensuring timely and accurate updates in RxCCR, enhancing overall operational efficiency.
Prior Authorization Pharmacy Technician
Health Support
11.2015 - 05.2016
- Handled member and provider calls, offering follow-up consultations on authorizations and appeals, enhancing customer satisfaction
- Applied benefit plan criteria to make informed decisions on approvals and denials, clarifying pharmaceutical benefits and procedures
- Navigated various computer systems to respond to inquiries, providing precise medication details and clinical information to improve service delivery
- Coordinated with team members to ensure accurate prescription processing and benefit clarification, fostering a collaborative work environment
- Implemented efficient prescription processing, improving data accuracy and compliance across multiple systems and enhancing overall workflow.
Education
Master in Public Health - Public Health
University of Arkansas Medical Sciences
Little Rock, ARCertificate - Public Health
University of Arkansas For Medical Sciences
Little Rock, ARBachelor of Arts - Biology
University of Arkansas
Fayetteville, ARHigh School Diploma -
Magnet High School
Little Rock, ARSkills
- Supervisory/Managerial Experience
- Public Speaking and Presentations
- Teamwork and Collaboration
- Analytical and Critical Thinking
- Project Planning and Development
- Written Communication
- Relationship Building and Networking
- Stakeholder Engagement
- Tableau
- Microsoft Office
- Salesforce
- Sharepoint
- ServiceNow
- Smartsheet
- AS400
- RxAuth
- RxClaim
- RxComet
- ICD 9-10 Codes
- Data Entry Specialist
- Advanced Problem-Solving
- Organization and Time Management
- Business Development
- Coaching and Mentoring
- Planning and Forecasting
- Data Analysis
- Project Management
- Health plans/Provider Experience
- Pharmacy
- Pharmacy Benefit Management (PBM) Experience
- Client Services
- Change Management
Certificates
- Pharmacy Technician II
- Nevada State Board of Pharmacy Technician Certificate
- Principles of Effective Learning Delivery Assistant (POET)
- OptumRx-Prior Authorization Department Subject Matter Expert
- Medicare & Retirement Certified Level 1
- Net Promoter Score Champion
Personal Information
Title: Physician Business Manager
Awards
Sages of Clinical Services Nominee
Timeline
Physician Business Manager
WellMed Medical Management Optum Care Delivery
04.2023 - Current
Provider Network Engagement Manager
United Healthcare
11.2021 - 04.2023
Associate Business Analyst
OptumRx Inc.
07.2019 - 11.2021
Senior Pharmacy Prior Authorization/Appeals Technician
OptumRx Inc.
05.2016 - 07.2019
Prior Authorization Pharmacy Technician
Health Support
11.2015 - 05.2016
Master in Public Health - Public Health
University of Arkansas Medical Sciences
Certificate - Public Health
University of Arkansas For Medical Sciences
Bachelor of Arts - Biology
University of Arkansas
High School Diploma -
Magnet High School
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