TONY OBREGON
FOUNTAIN VALLEY,CA
Summary
Seasoned Assistant Director knowledgeable about all areas of business operations. Offering 14 years of experience in Revenue Cycle, Provider Relations and Contracting. Recognized for strong decision-making skills while maintaining a high level of composure in fast-paced working environments. Demonstrated ability to multitask and produce consistent quality results.
Overview
12
12
years of professional experience
Work History
Assistant Director
Cigna
Remote, CA
03.2020 - Current
- Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups)
- Builds and nurtures provider partnerships with broader value-based business opportunities to support local market strategy
- Creates Healthcare Provider Agreements to meet internal operational standards and external provider expectations
- Responsible for accurate and timely contract loading and submissions, and interface with matrix partners for network implementation and maintenance
- Initiates and maintains effective channels of communication with matrix partners including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service
- Contributes to the development of alternative network initiatives
- Provides direction to develop network analytics for network solution
- Developed initiative to reduce and redirect non-participating lab tests resulting in approximately $1.2M in medical cost savings
- Assisted team with creating cost benchmark dashboards to support team members in contract negotiation
Experience Manager
Cigna
Remote, CA
01.2018 - 03.2020
- Managed external provider experience for assigned book of business
- Responsible for overall service delivery related to problem resolution, accounts receivable, and communication for assigned book of business
- Created, maintained individual provider strategic plans
- Identified service opportunities and risks for providers in national level and champion resolution, both internally and externally
- Educated and influenced providers on Cigna's business objectives, standard operating procedures, policies, and programs
- Managed end-to-end execution of corrective action plans, strategic and administrative for assigned Book of Business
- Collaborated with dedicated cross-functional service team to deliver ongoing service improvements
- Resolved service impacts and drove provider strategic planning solutions
Contract Operations Manager
St. Joseph Health System
Irvine, CA
06.2015 - 01.2018
- Established and maintained strong business relationships with executive-level staff and physicians to promptly resolve issues within a self-directed environment
- Reviewed and lead implementation of institutional and professional payer contracts with clinical and business departments under the supervision of Executive Director of Contract Operations
- Facilitated and lead meetings, both internally and with health plans, to resolve contract-related issues identified by Business Office, Case Management, Provider Relations, and other key departments
- Served as a liaison with health plans for further clarification or to share any objection to the policy
- Researched, developed, and maintained Contract Operation Tools, such as Health plan benefits and Division of Financial Responsibility Tool
- Managed Health Plan audits including financial audits, Medicare compliance, etc.
Contract Operations Specialist
St. Joseph Health System
Irvine, CA
06.2013 - 05.2015
- Distributed contracts, letters of agreement, hospital privilege waivers for all networks, hospitals, payers, and providers
- Maintained contract files and completed downstream financial audits as requested by health plans
- Trained departments regarding the Patient Protection and Affordable Care Act and the organization participation with various health plans
- Researched and reviewed contract documents regarding disputes received from contracted providers
- Reviewed and distributed industry newsletters to identify events and changes with potential impact on business
- Investigated continuity of care issues with utilization management and health plans until resolution has been reached
- Reviewed capitation contracts to determine financial responsibility of a certain item or service
Sr. Technical Denial Consultant
St. Joseph Health System
Orange, CA
04.2010 - 07.2013
- Tracked and managed denied accounts, including triaging clinical denials with the Clinical Denial Consultant to quickly evaluate medical necessity
- Identified and escalated consistent issues and trends with payers to support Revenue Cycle Services leadership in meeting with payers to resolve issues
- Reviewed insurance contracts to determine reimbursement rates
- Filed complaints regarding unfair payment practices to the applicable State and Federal Oversight agencies
- Maintained report for patient accounts to ensure prompt payment
Education
No Degree - Project Management Certification
University of California, Irvine
Irvine, CA2017
Bachelor of Arts - Sociology
Brandman University
Irvine, CA2012
Skills
- Database development
- Key relationship management
- Strategic planning
- Training and Development
- Interpersonal Communication
- Problem-Solving
- Project Management
- Operations Management
- Business Development
Professional Profile
Business Relationships Strategy: Managed and improved relationships with providers, and colleagues, both externally and internally, through honesty, interpersonal skills, and empathy.
Contract Negotiation: Effective negotiator with active listening skills and ability to view things from other perspective in order to reach mutual agreement between parties.
Communication: Skilled in translating complex information into common terms resulting in positive feedback from peers.
Training: Mentored and guided interns pursuing their interest in Healthcare industry. Adapted teaching methods to meet interns varying needs and interests.
Timeline
Assistant Director
Cigna
03.2020 - Current
Experience Manager
Cigna
01.2018 - 03.2020
Contract Operations Manager
St. Joseph Health System
06.2015 - 01.2018
Contract Operations Specialist
St. Joseph Health System
06.2013 - 05.2015
Sr. Technical Denial Consultant
St. Joseph Health System
04.2010 - 07.2013
No Degree - Project Management Certification
University of California, Irvine
Bachelor of Arts - Sociology
Brandman University
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