Tomiko T Vann
Atlanta
Summary
Accomplished Business Leader with a focus on creating and executing impactful initiatives that drive revenue growth. Demonstrated ability in project leadership and team development, establishing effective partnerships. Skilled in enhancing team productivity and achieving organizational goals while maintaining financial accountability.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Regional Provider Network Manager
Christian Care Ministry – Medi Share
01.2024 - Current
- Developed Guidelines for Network Managers, Trained New Hires, Implemented Department Playbook
- Implemented new policies and procedures to adhere to a faster turnaround, Restructured Data base for billing review.
- Provide oversight for issue resolution.
- Promoted and supported relationships to current providers, Regional Manager of 13 States (Ga,MA,MD,ME,MN,PA,RI,SC,SD,VA,VT,WI,WV)
- Contracted New Provider, Negotiation/SCA (Single Case Agreements)
- Develop project plans and lead projects that enhanced the PNM department.
- Contributes to strategy, goal setting, and updating policies and procedures for the department.
- Collaborates with internal and external partners for best practice.
Compliance Manager
Elevance (Anthem)
08.2022 - 12.2023
- Worked with State Agency to ascertain company approvals.
- Conducts complex investigations, document findings, and ensure corrective actions are made. Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
- Managed State Complaints
- Implemented New Plan Rollouts by way of Company Alerts
- Regulatory - manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Network Relations Consultant
Elevance
09.2015 - 07.2022
- Develops and maintains positive relationships with providers and develops strategies for recruitment and contracting.
- Develops and oversees contract approval process and non-standard and exception contract language and provision process/approvals.
- Researches, analyzes, and recommends resolutions for contract dispute, non-routine claim issues, billing questions and other practices.
- Coordinates communications process on such issues as administrative and medical policy, reimbursements and provider utilization patterns.
- Coordinates and conducts provider training.
- Facilitates Quarterly JOC Meetings with Facilities
- Servicing area of 40 Counties (50% of Amerigroup BH Providers)
- Monthly in Person Meetings with Providers
Credentialing Consultant
Elevance
08.2013 - 09.2015
- Develops and maintains positive relationships with Provider, Contractors, and Provider Relation Representative.
- Research, analyze, and recommends resolutions for applications, contracts, and non-routine claim issues.
- Coordinates communications with providers on issue with CAQH, GAMMIS, SAM, OIG, NPPES (NPI) as it relates to the Credentialing process.
- Daily Clean File report for Medical Director
- Posting of Re-Credentialing Notifications
- Monthly credentialing Termination Reporting
- Review Contracts in Emptoris
- Other daily reporting by Management, and/or other departments when needed.
Member Outreach Associates
01.2011 - 01.2013
- Provider members with information on how to access preventive Health maintenance service, while indentifying barriers of care.
- Educates members and providers about Plan Policies, programs, and services.
- Promotes and supports the PCP relationship.
- Provides telephone follow-up to ensure members have seen their PCP
- Refers issues and concerns about members to the Case Manager or Member Advocate as soon as identified.
- Records and reports all member outreach activity.
Finance/Account Operations Specialist BCBS of GA
Blue Cross Blue Shield
01.2002 - 01.2010
- Developed databases for analytical tools to measure financial outcome for Providers, Underwriters, and Sales team. Conducted presentation to upper management with finding on medical costs, and trends. (Produced month-end reporting of gains and losses for 80 groups for the different departments in Access and Excel format, Interpreted and communicated departmental and organizational policies and procedures to the Claims department, Groups, Providers, Underwriters, and upper management when needed.
- Responsible for performing diverse operational, financial and policy activities of a non-routine nature. (Eliminated duel reporting by creating one report with multi-functions.)
- Maintained internal controls, tracking reports, trend analysis. (Weekly Access, and Excel reporting with Pivot tables)
- Monitors and updates controls to ensure compliance, for HIPPA, and Earnest & Young and any auditor.
- Conducted independent analysis for multiple, complex and varied work process issues. With the understanding of HMO, PPO, POS, IND, Medicare, Medicaid, ICD-10, CPT, and Modifiers
- Receives validates and enters information into Finance systems.
- Enrollment Corrections, Researched group issues.
- Tracked and posted payments.
- Investigated and Resolved rate issues.
- Responds to customer questions via telephone and written correspondence.
- Analyzed problems and provided information and solutions.
- Developed and maintain positive customer relations. Coordinated with various departments with-in the company to ensure the customer’s request/questions are addressed in an appropriate amount of time.
- Provided external and internal customer service.
Member Service Rep BCBS of VA
01.1999 - 01.2002
- Processed claims (HMO), reviewed, analyzed and researched claims for reprocessing.
- Conducted investigation and reviews of customers and providers for claim appeals involving benefit coverage issues.
- Communicated disposition of case via mail. Work was time sensitive. Documented work for tracking
Education
BS - Management
Shorter University
Atlanta, Georgia01.2015
Skills
- Collaborative partnerships
- Research and assessment
- Program leadership
- Process improvement
- Project management
- Change facilitation
- Asset optimization
- Technology expertise
- Process optimization
- Negotiation skills
- Project leadership
- Coaching and mentoring
- Supply agreement management
- Sourcing analysis
- Training development
- Project scope definition
- Problem resolution
- Budget management
- Commercialization strategies
Websites
Certification
- Lean Six Sigma: Yellow Belt
- Lean Six Sigma: Green Belt
- Toastmasters
Timeline
Regional Provider Network Manager
Christian Care Ministry – Medi Share
01.2024 - Current
Compliance Manager
Elevance (Anthem)
08.2022 - 12.2023
Network Relations Consultant
Elevance
09.2015 - 07.2022
Credentialing Consultant
Elevance
08.2013 - 09.2015
Member Outreach Associates
01.2011 - 01.2013
Finance/Account Operations Specialist BCBS of GA
Blue Cross Blue Shield
01.2002 - 01.2010
Member Service Rep BCBS of VA
01.1999 - 01.2002
BS - Management
Shorter University