Tina M. Drahus, MSHA
Wyoming,PA
Summary
Insightful Manager with experience in directing and improving Provider Network Management, through effective employee motivational strategies and strong policy reinforcement. Proficient in best practices, market trends and regulatory requirements of provider network development. Talented leader with analytical approach to business planning and issue resolution.
Overview
24
24
years of professional experience
Work History
MANAGER, Provider Network Management
AMERIHEALTH CARITAS PENNSYLVANIA
SCRANTON, PENNSYLVANIA
09.2012 - Current
- Directly Responsible for:
- Network recruitment/contracting for New East Region build for AmeriHealth Caritas Northeast, Community Health Choices and Medicare network
- Established network adequacy for Medicaid, Medicare, Community Health Choices (CHC) and Healthy PA DHS/DOH/CMS network/exception submission.
- Integral in attaining Certificate of Occupancy in New East Region
- Facilitated credentialing/delegation per NCQA guidelines, to include delegated contracting
- Account Executive and Data Coordinator staff recruitment, management, development, training, and performance management
- Established Provider Network Education and Training, state and federal regulations
- Claims issue resolution to include system configuration updates
- Developed and Executed AmeriHealth Caritas Northeast PCMH/COE Conference
- AmeriHealth Caritas Northeast representative/presenter for American Association of Healthcare Administration Management (past board member)
- Conducted quarterly performance meetings HEDIS/CDPS/QEP/MQEP/Medication adherence,
- Value Based /Pay for Performance, Patient Centered Medical Home, and Centers of Excellence for Substance Use Disorders Contracting
- Facilitated Navinet, Electronic Funds Transfer and Electronic Claims submission Implementation increasing EFT compliance by 40%
- Reviewed Community Health Choices Agreement Pennsylvania Department of Health and Human Services, compiled deliverables establishing compliance of program/regulations
- Policy/Procedure/workflow creation/implementation
- Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals
MANAGER PHYSICIAN LIAISON PROGRAM
COMMUNITY MEDICAL
SCRANTON, PENNSYLVANIA
01.2009 - 07.2012
- Responsible for:
- Established Hospital/Physician Liaison program
- Developing Marketing plans/budgets
- Relationship management
- Monitoring new and changing federal and state regulations educate/ implement within hospital departments/physician practice
- Project management multidisciplinary/cross functional teams
- Implement operational changes establishing greater patient experience
- Development/Implementation of policy and procedures
- Report/Plan development
- Development committee member/special events director
- Performed Strategic Marketing/Outreach Physician/Hospital Services
- Facilitate Issue Resolution
- Community outreach educational programs
- CME/Trauma Symposia/Physician office staff educational seminars
- EHR-Provide access/training for medical staff.
PHYSICIAN LIAISON
GEISINGER HEALTH SYSTEM
WILKES, BARRE, PENNSYLVANIA
01.2005 - 01.2009
- Directly Responsible for:
- Increased Physicians Service volumes 20%
- Managed 9 county territory
- CME planning and facilitation, Physician Recruitment, issue resolution
- EHR –Provided access/training for employed and non-employed physicians/staff
- EPIC, Web ESA, ROI, LCR, Clinical Innovation Team integration with employed and
- On-employed physicians and staff
- Integral in Geisinger South Wilkes-Barre rollout
- Development/Implementation of policy and procedures
- Facilitate Issue Resolution
- Project management, Strategic Planning
- Directly communicate with senior leadership on market intelligence
- Partner with Pennsylvania Department of Health.
Ombudsman
HealthNow, NY
NANTICOKE, PA
02.2001 - 07.2005
- Directly responsible for:
- Program Education and Training Physicians, Suppliers CMS Medical policy/ billing procedures
- Facilitated change in national Medicare medical policy for External Silicone Breast Prosthesis
- Developed/conducted Medicare Modernization Act seminars
- Developed/ conducted HIPAA implementation seminars
- Planned/developed quarterly educational seminars in 10 state Region territory
- Partner Centers for Medicare and Medicaid Services
- Train Trainer seminars
- Operations/Claims issue resolution
- Medicare Beneficiary Outreach
- Medical Society Meetings
- Conducted CEU courses Physician State Association Meetings
- Developed procedures for Program Education and Training ISO 9000 certification
- Developed and Presented/Recorded /live web based education via WebEx.
TERRITORY MANAGER
PFIZER CO.
Morris Plains, NJ
01.1999 - 02.2001
- Directly responsible for:
- Territory Management Northeastern/Central Pennsylvania
- Inventory Management
- Sales over counter medications to Physicians, Dentists/Periodontists
- Training physician's staff drug related programs
- American Dental Association certified CEU educator Dentists, Periodontists and Dental Hygienists
- #1 US Sales Region 1999
Education
MSHA Masters of Science Healthcare Administration - Healthcare Administration
Kings College
Wilkes-Barre, PA05.2008
Bachelor of Science - Business Administration
College Misericordia
Dallas, PA05.1991
Skills
- Network management & development
- Rate Negotiation and LOA's
- Microsoft Office Suite, Quest Analytics, Facets, EXP Macess
- Excellent Presentation/Communication and Interpersonal Skills
- Relationship building
- Staff Recruitment, Development and Training
- Managed Care
- Provider Satisfaction Surveys
- Policies And Procedures
- Management Experience
- Strategic Planning
- Project Management
Accomplishments
- Betterway Challenge Finalist for The AmeriHealth Caritas Resident Education Program
- AmeriHealth Caritas Resident Education Program Pilot with The Wright Center for Community Health
- Managed the provider network development for the inaugural AmeriHealth Caritas Northeast Medicaid, Community Health Choices and Medicare plans. Achieved network adequacy for Medicaid, Medicare, Community Health Choices (CHC) and Healthy PA.
- Developed and Executed the AmeriHealth Caritas Northeast PCMH/COE Conference. (Patient Centered Medical Home/Centers of Excellence for Substance Use Disorders
- Increased Physicians Service volumes of the Geisnger Health System by 20%.
- Facilitated change in national Medicare medical policy for External Silicone Breast Prosthesis.
- Initiated the development of Annual Workshop Training for Specialists and Primary Care Physicians.
- Successfully completed two-week security training program.
Timeline
MANAGER, Provider Network Management
AMERIHEALTH CARITAS PENNSYLVANIA
09.2012 - Current
MANAGER PHYSICIAN LIAISON PROGRAM
COMMUNITY MEDICAL
01.2009 - 07.2012
PHYSICIAN LIAISON
GEISINGER HEALTH SYSTEM
01.2005 - 01.2009
Ombudsman
HealthNow, NY
02.2001 - 07.2005
TERRITORY MANAGER
PFIZER CO.
01.1999 - 02.2001
MSHA Masters of Science Healthcare Administration - Healthcare Administration
Kings College
Bachelor of Science - Business Administration
College Misericordia
Continuing Education
- Emotional Intelligence Seminars
- Leadership Seminars
- Customer Service and Employee Relations Seminars.
- Medical Seminars.
- Management Seminars.
- CMS National Customer Service Convention.
- CMS HIPAA Conference.
- Medtrade.
- SHSMD Conference.
- HAP Conference.
Continuing Education
- Emotional Intelligence Seminars
- Leadership Seminars
- Customer Service and Employee Relations Seminars.
- Medical Seminars.
- Management Seminars.
- CMS National Customer Service Convention.
- CMS HIPAA Conference.
- Medtrade.
- SHSMD Conference.
- HAP Conference.
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