Shannon Howard
Arlington Heights,IL
Summary
Seasoned contract negotiator in the Commercial, Medicare, and Medicaid space, possessing effective communication skills, attention to detail, and thorough follow through, with an interest in expanding into a leadership role and taking on more responsibility.
Overview
14
14
years of professional experience
Work History
Contracting Executive
Humana
12.2014 - Current
- Lead contract negotiations for high-value providers (value based and fee-for-service), securing advantageous terms for the company.
- Enhance provider satisfaction by streamlining communication channels and improving response times.
- Contribute to cost savings initiatives by renegotiating existing agreements for optimal financial outcomes.
- Develop, negotiate, and maintain contracts in Humana's chosen contract management software system (Merlin/Icertis).
- Back up HSD SME for Illinois with proficient knowledge in Medicare gaps, risk factors, and CMS requirements/guidelines in order to identify and close key Medicare gaps and maintain profitability.
- Help develop and manage provider networks that achieve financial objectives, provide quality products for costumers and a competitive advantage for Humana.
- Strong collaboration with Network Operations to ensure smooth transition from contracting through administration of contract.
- Maintain Operations meetings for key providers.
- Communicate proactively with other departments in order to ensure effective and efficient business results.
- Organize and lead quarterly meetings between the Market and Delegation Compliance
Contracting Manager
Molina Healthcare
06.2014 - 12.2014
- Negotiated agreements with highly visible providers who were strategic to the success of the Plan, including integrated delivery systems, hospitals and physician groups that resulted in high quality, cost effective, and marketable providers
- Negotiated high priority physician group and facility contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines
- Developed and maintained provider contracts in contract management software system (Merlin/Emptoris)
- Targeted and recruited additional providers to reduce member access grievances
- Engaged targeted contracted providers in renegotiation of rates and/or language
- Assisted with cost control strategies that positively impacted the Medicare Care Ratio (MCR) within each region
- Advised Network Provider Contract Coordinators and Specialists on negotiation of individual provider and routine ancillary contracts
- Evaluated provider network and implemented strategic plans with the goal of meeting Molina's network adequacy standards
- Assessed contract language for compliance with Corporate standards and regulatory requirements and reviewed revised language with assigned corporate attorney
- Educated internal staff on provider contracts
- Participated on the management team and other committees addressing the strategic goals of the department and organization
Network Developer (Contracting)
CorVel Corporation
06.2012 - 05.2014
- Developed and maintained relationships with healthcare organizations, hospitals, and major physician groups.
- Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
- Direct negotiation and contracting of targeted facilities and practitioners.
- Collaborated on strategies for re-contracting existing providers on updated contract templates to increase operational performance and adhere to regulatory compliance.
- Oversaw the development, expansion and maintenance of the provider network to include new provider identification and contract negotiation.
- Analyzed market data and financial models to continuously enhance provider network development.
- Used various reports and programming to identify key out of network providers and engage in contract negotiations.
- Conducted ongoing analysis and refinement of provider networks to ensure appropriate network composition.
- Educated new and existing providers on the changes within Worker's Compensation, specifically the Preferred Provider Program.
- Identified service gaps within the State of Illinois by provider type and engaged in negotiations to maintain adequacy and compliance within the Preferred Provider Program.
Provider Relations Representative
Aetna Better Health
03.2011 - 06.2012
- Served as a direct liaison between Aetna Better Health and the provider community.
- Developed strong relationships with network providers and internal business partners leading to the achievement of provider satisfaction.
- Developed and maintained relationships with clinical and business leaders of key physician groups, ancillary providers, hospitals and health systems.
- Deepened understanding of claims and claim processes, which included but was not limited to claim denial research, understanding of basic coding and fee schedules, and reimbursement as set forth by the Health Plan.
- Facilitated solutions that were mutually beneficial for both providers and the organization.
- Conducted ongoing analysis and refinement of provider networks to ensure appropriate network composition.
- Assisted with the identification of providers that enabled the Health Plan to address service gaps and implement pilot programs.
- Collaborated cross-functionally on complex issues to ensure provider needs were met and outstanding issues were resolved.
- Initiated provider contracting and worked closely with the Director of Contracting on ongoing contracting efforts.
- Leader in education, training, and oversight of the Provider community.
- Mentored 4 internal customer service representatives.
Credentialing Assistant
Edward Hospital
01.2010 - 06.2011
- Provider Relations Representative for all affiliates of Edward Management Corporation.
- Planned and scheduled meetings as it related to Provider Relations and Managed Care.
- Created and maintained professional and friendly working relationship with Managed Care Plans.
- Conducted on-site visits to meet with office personnel and representatives from Insurance and Managed Care Plans to represent our department and service our clients' needs.
- Credentialed and Recredentialed Medical Providers to ensure active affiliation with Managed Care Plans.
- Identified and resolved departmental issues related to, but not limited to, Managed Care Plans, Insurance Companies, and/or the Medical Provider.
Education
Bachelor of Arts - Corporate And Organizational Communications
Northern Illinois University
Dekalb, IL12.2009
Skills
- Interpersonal Skills
- Operations Management
- Team Player
- Networking abilities
- Contract drafting
- Strategic negotiation
Accomplishments
- Contracting Scholar
Timeline
Contracting Executive
Humana
12.2014 - Current
Contracting Manager
Molina Healthcare
06.2014 - 12.2014
Network Developer (Contracting)
CorVel Corporation
06.2012 - 05.2014
Provider Relations Representative
Aetna Better Health
03.2011 - 06.2012
Credentialing Assistant
Edward Hospital
01.2010 - 06.2011
Bachelor of Arts - Corporate And Organizational Communications
Northern Illinois University
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