Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

VANESSA VENTER

Temecula,CA

Summary

Dedicated Manager effective in creating positive environments where employees can increase productivity and succeed. Highly accomplished of training and development, business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results. Demonstrates a confident and well-developed business communication style, both written and orally that establishes strategic planning and execution. Recognized for a strong work ethic, integrity, and a high degree of personal initiative.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Contract Manager

Providence
Irvine, CA
03.2024 - Current
  • Responsible for leading, or participating as a team member, in significant negotiations with Payors for acceptable reimbursement terms and contract languages for all facility agreements in the CA market.
  • Created Health Plan Participation grid and DOFR grid.
  • Continuously work on major health plan renewals and Mental Health/Transplant Networks (carve outs) to finalize hospital renewals.
  • Oversee revenue primarily associated with Commercial, Medicare Advantage, and Medicaid products.
  • Develop complex negotiation strategies and secure acceptable terms.
  • Ensure every contract and negotiation aligns with our organization's goals to maximize reimbursement while minimizing financial risk.
  • Periodically engage in public speaking and presentations, demonstrating knowledge of annual utilization, payor mix, and reimbursement.

Senior Contract Specialist

Scripps Health
Rancho Bernardo, CA
06.2019 - 03.2024
  • Responsible for the daily operation of the contractual provider and stakeholder relationships
  • Overseeing accurate and current provider databases, developing and providing provider training, education, and communicating information to ensure regulatory compliance
  • Review, draft and document agreements and ensure language meets all state and federal regulatory and NCQA standards
  • Strong knowledge of contract configuration, capitated risk, and division of financial responsibility interpretation, contract rate, language negotiation and interpretation, claims payment and member or provider eligibility
  • Review and have complex disputes reprocess requiring a more in-depth understanding of appropriate payment methodologies or denial practices, benefits, policies and procedures and contract interpretation
  • Participate in weekly meetings as necessary, including but not limited to, senior leadership, UM department, claims, IT, health plans, and team building
  • Gather, review and submit credentialing applications to CCS and provide assistance throughout the credentialing process
  • Create updates and changes for contracted providers and non-contracted providers by submitting tickets on Epic

Office Manager- (Contract)

HMT
Compton, CA
07.2018 - 10.2018
  • Develop and maintain project schedule, and budget to ensure project meets initial estimates
  • Responsible for month-end financial reviews, including WIP report, and purchase orders review, purchase card logs, project budgeting, accounts payable aged report, and operational expense review
  • Coordinate ISN training among new employees and ensure they complete all modules according to job title
  • Administer all LOA, hiring, termination, PTO, transfers, or promotions, using ADP
  • Conducts investigations pertaining to workplace issues, incident reports, and PAN notices
  • Weekly, hourly and salary payroll processing and filing for 62 employees
  • Manage employee benefit programs including health plans, life, vision, dental and disability
  • Develops and presents educational materials regarding benefits
  • Handle recruitment and onboarding process-E-Verify, drug, hair, oral screening, background check, references, and review all new hire paperwork for accuracy
  • Accounts Payable- track all invoices, verify discrepancies, assist vendors with billing inquires, reconcile vendor accounts, and enter bills into Solomon accounting software

Contract Administrator (Contract)

Coast Healthcare Management
Cypress, CA
01.2018 - 04.2018
  • Supervision of contracting staff
  • Develops the provider network through contract negotiations, relationship development and service special projects
  • Responsible for New Provider and Staff Orientations and oversight of their assigned networks to ensure network provider deficiencies are being met
  • Daily interaction with providers and at minimum quarterly visits to PCP and Specialist offices
  • Works collaboratively with internal departments and staff to produce reports as requested
  • Maintained a database for collecting the appropriate data and data-enters information thoroughly and accurately
  • Gather operational and process/workflow requirements from customers with a comprehensive understanding of claims and contracts
  • Analyze and document existing data reports, incorporating relation to audits from health plans
  • Develop and communicate special projects with external departments
  • Negotiate all Retro Memorandum of Understanding and create contracts, amendments, and MOUs
  • EZ Cap Non-Contracted Provider and Vendor Loads for all IPAs as received from Claims and UM department

Member Retention Coordinator (Contract)

Regal Medical Group
Orange, CA
01.2017 - 09.2017
  • Assign and communicate projects to department staff
  • Collaborate and report statuses on projects to management
  • Complete projects with specific timeline
  • Create, implement & maintain a payroll procedures manual
  • Prepare weekly tracking report of department expenses
  • Manage extensive and complex calendar, including meetings planning, scheduling, and preparation of meeting logistics
  • Process payroll- Reviewing timesheet information to ensure completed timesheets
  • Documents, tracks, and closes provider/member issue
  • Oversight of database maintenance and accuracy through use of audits
  • Attend department meetings to implement action items, solutions, techniques, and to achieve goals on current projects
  • Assist in the interview/hiring process with potential candidates

Administrator (Contract)

MemorialCare Home Health
Laguna Hills, CA
02.2015 - 09.2016
  • Provides oversight, problem-solving and support in collaboration with home health discharge
  • Establishing goals, objectives and monitoring mechanisms for employee performance and developing corrective action plans
  • Conducting individualized supervisory meetings with agency staff to review and monitor plans of care
  • Attends Medical Executive weekly meetings and submits required reports
  • Perform detailed analysis of data, procedures, and skills in order to execute projects
  • Presents and reviews pertinent health related information with member, including post-discharge instructions, urgent care options, and benefits information for members
  • Contribute to team efforts by accomplishing goals and related results

Education

Bachelor of Science - Management

University of Phoenix
Tempe, AZ
01.2019

Skills

  • Ability to build relationships and influence others
  • Bilingual
  • Teamwork
  • Accountability and execution oriented
  • Conflict Resolution
  • Time Management
  • Forward-planning and strategy
  • Project management
  • Ambitious
  • Adaptability and flexibility
  • Creativity and critical thinking skills
  • Proficient in MS Office

Certification

  • Business Contracts-Cornell University Law School (2024)

Timeline

Contract Manager

Providence
03.2024 - Current

Senior Contract Specialist

Scripps Health
06.2019 - 03.2024

Office Manager- (Contract)

HMT
07.2018 - 10.2018

Contract Administrator (Contract)

Coast Healthcare Management
01.2018 - 04.2018

Member Retention Coordinator (Contract)

Regal Medical Group
01.2017 - 09.2017

Administrator (Contract)

MemorialCare Home Health
02.2015 - 09.2016

Bachelor of Science - Management

University of Phoenix

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