Rosalyn Y. Phillips
Stockbridge,GA
Summary
Dedicated healthcare professional with extensive experience in care management organizations, specializing in coordinating patient-centered care, improving health outcomes, and optimizing healthcare operations. Adept at developing and implementing care management strategies that enhance service delivery, ensure compliance, and improve patient engagement. Proven ability to collaborate with interdisciplinary teams, analyze healthcare data, and drive process improvements to achieve organizational goals. Passionate about streamlining care coordination, reducing costs, and enhancing the overall patient care.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Statewide Manager, Provider Relationship Account Mgt
Amerigroup
01.2021 - Current
- Manage provider relations, ensuring issues are resolved efficiently and provider education/orientation is conducted effectively
- Oversee network adequacy evaluations, provider recruitment, and marketing initiatives to strengthen provider networks
- Lead provider advisory group meetings, securing actionable feedback on company initiatives and enhancing provider engagement
- Monitor team performance, ensuring high standards are met and operations are effective
- Hire, train, coach, and evaluate direct reports, fostering a collaborative and team-oriented environment
- Implement innovative solutions to provider issues, enhancing critical and creative thinking within the team
- Managed a team of 16 in provider relationship account management, providing leadership to achieve goals in line with network strategy
- Interface with key providers to maintain superior relationships and expand clientele by offering market-appealing services
- Enhance audit and validation processes, ensuring network integrity and recovering overpayments due to system issues
- Recovered $500k in overpayments through enhanced audit and validation processes, improving quality management standards
- Reduced claims processing errors by more than 3.5%, amplifying provider satisfaction and reinforcing network strategy objectives
- Developed and implemented a tracking system for vendor management, recognized for improving operational efficiency and oversight
- Devised and deployed best practices and process improvements for quality, training, and employee retention
- Created policies and procedures for vendor management, establishing framework for consistent and effective vendor interactions
- Led team to complete full audits for Special Investigations Unit, rigorously investigating providers and reviewing claims for compliance
- Drove organizational corrective actions based on provider feedback, improving provider satisfaction and claims processing
Network Relations Manager II, (Operations Oversight)
Amerigroup
01.2017 - 01.2021
- Managed comprehensive oversight of operational processes for a multi-state healthcare network, ensuring adherence to regulatory standards and contract compliance
- Conducted in-depth audits of provider files and Special Investigations Unit, leading to identification of critical compliance issues and implementation of corrective actions
- Orchestrated vendor contract reviews, creating Statements of Work and Business Associate Agreements to safeguard health plan's interests
- Championed development and facilitation of Tele-Health billing training programs for educational agencies and health clinics, enhancing service delivery and operational efficiency
- Recognized by five states for creation of innovative network management tool, streamlining operations and improving service quality
- Spearheaded completion of Compliance Assessment Tool, resulting in enhanced compliance levels with contractual requirements
- Led facilitation of New Provider Orientation, elevating provider engagement and knowledge within Georgia Health plan
- Utilized National Executive Dashboard to identify and address reporting gaps, operational SLAs, and contract requirements, ensuring continuous performance improvement
- Directed provider termination and vendor management workgroups, optimizing network integrity and vendor relations
Regional Provider Relations Manager
Amerigroup
01.2009 - 01.2017
- Managed regional provider relations and coordinated comprehensive training programs to enhance service delivery for both internal and external stakeholders
- Ensured adherence to state contract rules and conducted thorough claims analysis for large Independent Physician Associations (IPAs)
- Developed and implemented new policies and procedures to address process gaps, leading to improved operational efficiency
- Oversaw account management, including provider representative visits, maintaining meticulous documentation in Salesforce, and ensuring prompt provider responses
- Spearheaded educational initiatives on innovative contracting strategies and managed entry and testing of provider demographic changes
- Successfully trained school-based clinic staff, enhancing telephone communication and service quality
- Fostered collaboration with Special Investigations Unit, contributing to several years of joint efforts in fraud prevention
- Streamlined audits and problem resolution processes, establishing dedicated team for swift issue handling
- Pioneered educational programs on health plan contracting, referrals, claims submission, and web portal utilization, increasing provider engagement and compliance
- Orchestrated data management for network changes, ensuring accuracy and efficiency in provider information updates
- Increased provider satisfaction scores 90% by collecting and credentialing demographic updates, investigating claims and inquiries and overseeing network integrity.
- Reduced project downtime 80% and boosted client retention 95% by maintaining practitioner contract stipulations and addressing grievances.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Developed, reviewed and prepared all provider education material, increasing efficiencies in processes 100%.
- Developed, reviewed and prepared [Type] and [Type] provider education material, increasing efficiencies in processes [Number]%.
- Increased provider satisfaction scores [Number]% by collecting and credentialing demographic updates, investigating claims and inquiries and overseeing network integrity.
- Reduced project downtime [Number]% and boosted client retention [Number]% by maintaining practitioner contract stipulations and addressing grievances.
- Brought in [Number] new providers to enhance coverage and meet program goals.
Compliance Auditor
Georgia Department of Community Health
01.2005 - 01.2009
- Conducted comprehensive compliance audits within the healthcare sector, focusing on adherence to state and federal regulations
- Developed and implemented audit protocols to ensure systematic evaluation of processes and practices
- Managed vendor relationships to maintain high performance against KPI metrics, ensuring operational excellence
- Analyzed and interpreted complex compliance data to identify areas for improvement and risk mitigation
- Provided guidance and recommendations to enhance organizational compliance posture
- Exceeded audit completion targets by 20% through the development of a streamlined audit process
- Improved vendor compliance by 15% by enforcing strict adherence to contractual KPIs and conducting regular performance evaluations
- Enhanced accuracy of compliance reporting by implementing a new data analysis protocol, reducing errors by 25%
- Performed over 30 compliance audits per month.
- Prepared reports for templates and maintained compliance database.
- Analyzed all audit results and resolved all compliance issues.
- Performed over 30 compliance audits per month.
- Participated in various training and development programs.
Education
Associate of Science - Healthcare Management
Southern New Hampshire University
12-2026
Skills
- Vendor Account Management
- Provider Relationship Management
- Team Leadership & Development
- Operational Efficiency Improvement
- Cross-functional Collaboration
- Process Improvement
- Quality Management
- Performance Metrics Analysis
- Strategic Planning & Execution
- Healthcare Network Development
- Risk Assessment
- Network Adequacy
- Provider Recruitment
- Contract Negotiation
- Regulatory Compliance
Accomplishments
- Provider Education Initiatives: Led the facilitation of New Provider Orientation, elevating provider engagement and knowledge within the Georgia Health Plan.
- Operational Performance Improvement: Utilized the National Executive Dashboard to identify and address reporting gaps, operational SLAs, and contract requirements, ensuring continuous performance improvement.
Certification
Certified Medical Biller
Timeline
Statewide Manager, Provider Relationship Account Mgt
Amerigroup
01.2021 - Current
Network Relations Manager II, (Operations Oversight)
Amerigroup
01.2017 - 01.2021
Regional Provider Relations Manager
Amerigroup
01.2009 - 01.2017
Compliance Auditor
Georgia Department of Community Health
01.2005 - 01.2009
Certified Medical Biller
Associate of Science - Healthcare Management
Southern New Hampshire University
Similar Profiles
Lorna E. KachajeLorna E. Kachaje
Outreach Care Specialist at AmerigroupOutreach Care Specialist at Amerigroup
Rhonda SmithRhonda Smith
Nursing Facility Provider Consultant at AmerigroupNursing Facility Provider Consultant at Amerigroup
Ashley PoteetAshley Poteet
PCA at AmerigroupPCA at Amerigroup