Summar Robinson
Land O'Lakes,FL
Summary
Dedicated professional who excels at using proven methods to successfully cut costs, streamline operations, and increase productivity. Assertive and enthusiastic, with extensive knowledge of process optimization and an unsurpassed work ethic.
Overview
19
19
years of professional experience
Work History
Provider Network Manager Senior
Simply Healthcare
10.2019 - Current
- Provider account management, credentialing, re-credentialing, site visits, claims research, contract negotiation and execution
- Financial discussions with Value Based Agreement Providers to include service fund and utilization review
- Collaborates with providers/groups to develop systems to increase performance
- Serves on SME committees on various topics that include Service fund and Value Based Agreements
- Collaborates with peers on internal and external teams on a continual basis to create efficiencies
- Provider education with policies and procedures
- Meets deadlines when given tasks required for regulatory purposes and otherwise
- HEDIS/ Care Gap education and record collection
- Efficient use of multiple computer system platforms
Provider Operations Manager
veriMED IPA, LLC/Primecare, LLC
10.2007 - 10.2019
- Collaborates with marketing department for recruitment of new physicians to participate with Medicare Advantage Plans to achieve membership growth
- Liaison to primary care physicians and employees who participate in Risk Model Methodology to various Medicare Advantage Plans
- Educates medical office staff on benefits and strategies of 'Gate Keeper Model' to reduce unnecessary health care waste
- Ensures medical practices maintain high HEDIS scores
- Continuous assistance and education provided regarding efficient utilization strategies to improve scores for better patient outcomes and cost management
- Meets monthly with physicians to review service fund data
- Analyzes and identifies potential causes of deficits and develops strategies for improvement on a monthly basis
- Networks with specialists and ancillary providers to align contracting needs
Provider Relations Representative
Transatlantic Healthcare, LLC
12.2005 - 10.2007
- Created relationships to align PCP's with a brand new IPA
- Participated with marketing for all providers and the Medicare Advantage Plan
- Provided training for affiliated providers and their staff on being the "medical home" for members.
- Monitored all inpatient admissions and ensured prompt in office follow up after discharge
- Identified members to consider for case management
Education
General Education Diploma -
03.1995
Skills
- Ability to understand strategic business requirements
- Aptitude for directing, motivating, and developing teams
- Ability to manage multiple assignments and projects simultaneously
- Robust understanding of Medicaid and Medicare payment and funding methodologies
Timeline
Provider Network Manager Senior
Simply Healthcare
10.2019 - Current
Provider Operations Manager
veriMED IPA, LLC/Primecare, LLC
10.2007 - 10.2019
Provider Relations Representative
Transatlantic Healthcare, LLC
12.2005 - 10.2007
General Education Diploma -
Similar Profiles
Carlos SeguiCarlos Segui
Contract Coordinator & Account Manager at Simply HealthcareContract Coordinator & Account Manager at Simply Healthcare
LUDMILA JIMENEZLUDMILA JIMENEZ
Benefits Consultant at Simply Healthcare Plans Inc.Benefits Consultant at Simply Healthcare Plans Inc.
YONELA GUBHANAYONELA GUBHANA
Clinics Administrator - Contract at Kaelo Simply HealthcareClinics Administrator - Contract at Kaelo Simply Healthcare