Shawn Eason
West Columbia
Summary
A highly motivated and positive individual with great negotiation, organizational, and communication skills. Customer service master and efficient problem solver. Deftly manages administrative functions. Provides thorough answers and solutions as well as exception provider relations.
Overview
21
21
years of professional experience
Work History
Senior Provider Contracting Executive
Curana Healthcare
Raleigh
10.2023 - Current
- Build and maintain effective relationships with hospital and physician leadership, navigating political and organizational dynamics while advancing strategic contracting objectives.
- Support network expansion and physician recruitment initiatives within assigned geographic regions.
- Represent contracting at external and Joint Operating Committee meetings.
- Work with Provider and legal teams on red line language review.
- Provides mentoring to less experienced team members and is accountable as a role model for customer service excellence.
Contract Specialist
Contigo Healthcare
Charlotte
06.2023 - 10.2023
- Develop and manage TPA, COE Networks.
- Renegotiates provider's contract when terming.
- Build relationships with providers while assisting with any issues.
- Act as a resource to answer any contracting questions.
- Validate roster and submit updates to be loaded.
Manager, Provider Network Management
Thriveworks
Lynchburg
01.2022 - 06.2023
- Build strong, collaborative relationships and agreements with payors by negotiating new partnerships and renegotiating existing ones.
- Execute the implementation process of contracts including collaborating with billing and credentialing departments as well as other key stakeholders to ensure contract implementations is optimized.
- Strong focus on contracting, reporting, and operations to optimize performance.
- Assist in the identification and sourcing of partners for value-based arrangements.
- Research, develop, negotiate, and implement payor contracting strategies.
- Help identify and lead process improvements and development as the company continues to scale.
Provider Contracting Specialist
Paradigm Specialty Clinic
Tampa
02.2021 - 12.2021
- Calls physician prospects to explain company services and solicit/negotiate with them to accept referral via single case agreements.
- Deploy tactful negotiation skills to add provider in network.
- Utilize proprietary company information/programs as well as non-company systems to identify physician prospects and identify optimal reimbursement range.
- Act as a resource to answer any contracting questions.
- Establish relationships with providers.
Provider Relations Specialist II
Absolute Total Care
Columbia
08.2011 - 02.2021
- Act as a liaison between the provider and the Managed Care program ensuring a coordinated effort in improving financial and quality performance.
- Provide extraordinary customer service with members, payer relationships and with external contacts by exceeding expectations, providing effective and complete communication and creating positive resolutions.
- Review network for network adequacy.
- Represented the company in contract negotiations, obtaining favorable terms with persistence and a knowledgeable approach for Hospitals, Physicians, Ancillary, DME providers.
- Developing mechanism to identify and address systemic contract issues for appropriate mitigation.
- Maintain a thorough knowledge of all aspects of payers' strategies, policies, procedures, quality measures, facility services and community/public status.
- Troubleshoot problems and developed successful solutions.
- Educated providers regarding policies and procedure related to referrals, claims submission, credentialing documentation, and web site education.
- Provide oversight on inquiries and claims issues and follow up with providers to ensure problems resolved.
- Train new employees on policies and procedures and give guidance on day-to-day issues and functions.
- Reimbursement structures: Pay for Performance, CMS cost Sharing, Hospital Readmission Reduction (HRR), Value Based and Acquired Condition Adjustment.
Bill Review Specialist
Companion Property and Casualty Insurance Company
Columbia
12.2007 - 08.2011
- Review new files to determine current status of injury claims and to develop a plan of action.
- Collaborated with claims department and industry anti-fraud organization to resolve claims.
- Followed up with insured individuals regarding premium and deductible payments.
- Researched claims and incident information to deliver solutions.
Office Billing Manager
Midlands Cardiology Associates
Columbia
11.2004 - 12.2007
- Oversaw internal controls, setting up systems and enforcing policies to keep operations fully compliant with applicable regulations.
- Served customers by going above-and-beyond to offer exceptional support for all needs.
- Troubleshoot problems and developed successful solutions.
- Helped team handle high-volume work by prioritizing tasks and organizing supplies.
- Generated financial statements and reports detailing accounts receivable status.
- Disturbed petty cash by recording entries and verifying documentation.
- Trained and mentored new team members.
- Documented meeting minutes and disturbed to staff to facility follow up and permanent record.
- Investigated and resolved customer complaints to foster satisfaction.
Education
General Studies -
Gateway Senior High School
Monroeville, PA06.1987
Associates - HealthCare Management
Penn Foster University
Scranton, paSkills
- Process analysis
- Issue research
- Customer relations
- Medical Terminology
- Contract Negotiation
- Computer proficient
- Knowledge Medicare and Medicaid Guidelines
- Detailed oriented
- CMS and Commercial pricing and methodologies
Timeline
Senior Provider Contracting Executive
Curana Healthcare
10.2023 - Current
Contract Specialist
Contigo Healthcare
06.2023 - 10.2023
Manager, Provider Network Management
Thriveworks
01.2022 - 06.2023
Provider Contracting Specialist
Paradigm Specialty Clinic
02.2021 - 12.2021
Provider Relations Specialist II
Absolute Total Care
08.2011 - 02.2021
Bill Review Specialist
Companion Property and Casualty Insurance Company
12.2007 - 08.2011
Office Billing Manager
Midlands Cardiology Associates
11.2004 - 12.2007
General Studies -
Gateway Senior High School
Associates - HealthCare Management
Penn Foster University