Stacey Sarmiento
Experienced Contract Specialist
Las Vegas,NV
Summary
Rational Healthcare Consultant with 15 years of experience enhancing operations for organizations through information systems solutions. Proven track record of transforming specific business goals related to growth and efficiency improvements into new healthcare systems. Knowledgeable innovator known for recommending new technologies to enhance existing systems and introduce new systems. I'm a reliable employee offering excellent communication and good judgment. Posses excellent time management and problem-solving skills who's hard work, passion and organizational skills resonate. Ready to ensure company goals are achieved because of consistent, organized practices. I flourish under pressure by quickly adapting to new situations and challenges to best enhance the organizational brand.
Overview
13
13
years of professional experience
Work History
Population Health Analyst (Contractor)
Ami Network
Santa Monica, CA
05.2021 - 05.2022
- Led the design, development, execution dissemination and interpretation of clinical and pop health analyses, metrics and reported using clinical, member, financial and administrative data to identify, develop and/or monitored actionable opportunities or improving healthcare outcomes and clinical quality and costs of care, efficiently and effectively managing projects to successful completion
- Served as strategic business consultant to internal and external stakeholders as demonstrated by providing subject matter expertise, and by anticipating and actively proposing, designing and executing analyses
- Provided consultative, techinical, subject matter and business expertise mentorship to colleagues across the enterprise
- Identified gaps in care from network practices and collaborated with leadership to execute activities to fill those gaps
- Utilized and monitored NRC Health portal which housed the CAHPS/HOS analytics for the human understanding program and provided advanced analytics to drive quality, loyalty and growth and reported those metrics to the clinical performance team, patient experience and provider performance
- Used Salesforce, Epic, Allscripts, Cerner and Coceva-Value Based Care operating system to conduct and report healthcare metrics
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
ISNP Medicare Consultant (Consultant)
Longevity Health Plan
Las Vegas, NV
08.2021 - 01.2022
- Areas of responsibility included identifying key providers by supporting and coordinating contracting efforts by developing relationships with IPAs, hospitals, and key specialty services.
- Discussed comprehensive contractual arrangements which required a depth of understanding of managed care; negotiations, and various high-volume services.
- Followed a facility-specific strategy and work plan for the assigned facilities and was responsible for the ongoing management of ISNP products/services at those facilities including their relationship with network providers.
- Main point of contact between facility and plan. Collaborated with facility management and staff to ensure quality services are provided to members and plan administrative functions are carried out effectively.
- Supported the ongoing contract and relationship maximization with network providers. This included facilities, individuals, networks, using a diverse range of techniques and contracting ''best practices'', including capitation, case rates, and various fee for services arrangements.
- Collaborated with provider network and contracting team in the development of the region-wide contracting strategy then supported the management and implementation as required. This included specialty services that aligned with plan and network contract interests contract interests.
- Managed contractual relationships to ensure accurate administration of contract terms. Lead and participated in multidisciplinary teams comprised of health plan contracted provider representatives and leadership.
Managed Care Contract Analyst (Contractor)
Optum, UnitedHealth Group
Las Vegas, NV
03.2021 - 06.2021
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Network build project for Nevada RFP, conducted outreach to Medicaid providers to gage participation, negotiated rates and explained methodology to prospective providers
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio.
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for network contracts.
- Input data into system and recorded order updates with 100% accuracy.
- Enhanced organization and traceability through implementation of management systems, sharepoint
- Sourced and qualified providers, obtained favorable pricing and finalized contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Conducted research, gathered information from multiple sources and presented results.
- Sent materials via email and verified all contract contents for submittal to credentialing for processing
Network Development Manager (Contractor)
Cano Health Plan- Florida
Las Vegas, NV
09.2020 - 02.2021
- Negotiated executed physician and/or provider contracts in accordance with company standards in order to maintain and enhance provider networks, while meeting and exceeding accessibility, quality and financial goals for DCE (Direct Contracting Entity) contract execution for upcoming year.
- Established the plans network management strategic vision to pursue providers in NM, AZ and NV.
- Developed and implemented a value based program that incentivized and rewarded quality by leading the health plan in network design to support the growth and performance objectives of the health plan.
- Built and developed strong relationships with the provider community to ensure that contractual relationships lead to meaningful and effective partnerships that balanced the best interests of the organization's members, providers and the states healthcare community.
- Ensured compliance with applicable regulatory and internal requirements, including network reports for the department and other internal/external clients, regulators, and accrediting bodies.
- Strong business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the health care industry serving a diverse social and ethnic population
Population Health Analyst (Contractor)
CommonSpirit Health- Dignity Health Plan
Phoenix, AZ
11.2017 - 01.2020
- Project manager for Population Health Management for Common Spirit Health- Dignity Health Plan who provided an experience and environment of patient- and family-centered care for their network.
- Guided acquisition process to capture projected cost and revenue synergies to move combined organization forward.
- Performed quality assurance analysis to meet appropriate standards and facilitate improvement of those processes.
- Interpreted impact of broad scope organizational change for staff and leadership for successful implementation
- Developed and managed operational initiatives with measurable outcomes.
- Formulated objectives, goals and strategies collaboratively with other stakeholders and prepared reports to operational leadership outlining progress toward meeting annual goals and objectives, that included performance related outcomes.
- Continually assessed all services, identified problems, utilized data to analyze and propose innovative approaches for solutions.
- Organized and prioritized time and resources to manage efficiency.
- Appropriately delegates and demonstrated achievable, measurable results and developed action plans for improvement of data received.
- Developed and implemented measures for quality improvement, cost and complication reduction, and the implementation of evidence-based programs. Incorporated the use of evidence based practice and appreciative inquiry into program development and improvement activities for health plan.
- Articulated and presented data, information and ideas in a clear and concise manner who effectively facilitated meetings at population health and clinical informatics organizational level.
- Communicated with physicians, clinical department leaders, and senior administrators to maintain coordination with other DH and CSH programs.
- Managed the complex interdepartmental and interdisciplinary relationships to assure collaboration and effective/efficient operations within population health and its subsidiaries.
Epic Trainer
Par8o Referral Management
Boston, MA
12.2015 - 04.2017
- Verified long-term staff excellence by implementing updated and continuous training initiatives such as online modules, interactive programs and language labs.
- Created and oversaw training programs for operations.
- Developed and implemented, updating training programs for participating network providers.
- Developed lesson plans, instructional materials and written practice tests to conduct training sessions.
- Trained and mentored new personnel hired to fulfill various roles.
- Liaised between executives and entry-level workers, facilitating smooth communication.
- Prepared variety of different written communications, reports and documents.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Delivered services to customer locations within specific timeframes.
- Used Microsoft Word and other software tools to create documents and other communications.
- Epic certified
Managed Care Contract Specialist
Anthem
Las Vegas, NV
08.2013 - 12.2015
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for managed care contracts.
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio and area.
- Identified network gaps and recruited providers based on network need.
- Sourced and qualified providers who interdependently sought us out for capitated mutually beneficial pricing and agreements and finalized those contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Participated in continuous improvement by generating suggestions and continual engagement with network in problem-solving activities to support teamwork and collaboration.
Managed Care Contract Specialist (Manager)
Bravo Health
Baltimore, MD
06.2011 - 08.2013
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio.
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for service contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for managed care contracts (Medicare)
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio and area.
- Identified network gaps and recruited providers based on network need.
- Sourced and qualified providers who interdependently sought us out for mutually beneficial pricing and agreements and finalized those contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Participated in continuous improvement by generating suggestions and continual engagement with network in problem-solving activities to support teamwork and collaboration.
Network Contracting Specialist
Aetna
Las Vegas, NV
06.2008 - 05.2011
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio.
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for service contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Worked collaboratively with administrative staff in negotiation, correspondence, documentation and compliance checks for managed care contracts (Medicare)
- Verified submitted documents for completeness and compliance with company policies, addressing discrepancies and collaborating to troubleshoot where necessary.
- Developed and followed processes to manage contracts and remain in compliance with company commitments and regulatory obligations.
- Worked with internal and external parties to maximize value of assigned contracts in company portfolio and area.
- Identified network gaps and recruited providers based on network need.
- Sourced and qualified providers who interdependently sought us out for mutually beneficial pricing and agreements and finalized those contracts.
- Maintained effective and lasting vendor relationships through dynamic communication, collaboration and intelligent questioning skills.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Participated in continuous improvement by generating suggestions and continual engagement with network in problem-solving activities to support teamwork and collaboration.
Education
Bachelor of Arts - Psychology
University of New Mexico
Albuquerque, NM 05.2001 -
Skills
Communication
undefinedWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
The opposite of a true statement is a false statement, but the opposite of a profound truth may well be another profound truth.
Niels Bohr
Timeline
ISNP Medicare Consultant (Consultant)
Longevity Health Plan
08.2021 - 01.2022
Population Health Analyst (Contractor)
Ami Network
05.2021 - 05.2022
Managed Care Contract Analyst (Contractor)
Optum, UnitedHealth Group
03.2021 - 06.2021
Network Development Manager (Contractor)
Cano Health Plan- Florida
09.2020 - 02.2021
Population Health Analyst (Contractor)
CommonSpirit Health- Dignity Health Plan
11.2017 - 01.2020
Epic Trainer
Par8o Referral Management
12.2015 - 04.2017
Managed Care Contract Specialist
Anthem
08.2013 - 12.2015
Managed Care Contract Specialist (Manager)
Bravo Health
06.2011 - 08.2013
Network Contracting Specialist
Aetna
06.2008 - 05.2011
Bachelor of Arts - Psychology
University of New Mexico
05.2001 -
Similar Profiles
NChan Zion TsengNChan Zion Tseng
General Manager at Ami Sushi RestaurantGeneral Manager at Ami Sushi Restaurant
David SharpDavid Sharp
Director of Development & Sales at AMI GroupDirector of Development & Sales at AMI Group
IDAN SHIMSHONIIDAN SHIMSHONI
System Engineer at Philips Medical Ltd, CT/AMI R&D DivisionSystem Engineer at Philips Medical Ltd, CT/AMI R&D Division
Shauna HallahanShauna Hallahan
Paralegal at Fuller Law PracticeParalegal at Fuller Law Practice
Anthony CervantesAnthony Cervantes
Server Assistant at Mastros Ocean ClubServer Assistant at Mastros Ocean Club