Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

YANET OCHOA

Los Angeles County

Summary

Highly motivated, experienced and resourceful professional with over 20 years in managed care and proven skills in managing and negotiating contracts seeks a position in which current knowledge and abilities can be developed and strengthened to benefit the organization.

Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.

Overview

14
14
years of professional experience

Work History

Director of Managed Care

International Equity Partners, Inc
08.2021 - 08.2025
  • Negotiate contracts for over 20 Skilled Nursing Facilities in Los Angeles County, Sacramento, and Fresno.
  • Managed to review contract language and reimbursement rates.
  • Assist each facility to obtain targeted contracts as well as single case agreements.
  • Teach and educate internal departments in understanding contracts and new rate review.
  • Interact with facility personnel, admissions, clinical and billing departments.
  • Implementing strategic roles for the advancement of clinical and quality performance for over 20 Skilled Nursing Facilities.
  • Lead in the overall development and implementation of local managed care strategy and tactics.
  • Continually develop effective relationships with key stakeholders externally and within the organization including executive leadership players and board members.
  • Secure support for negotiation goals with internal and external constituents.

Experience Provider Contract Specialist, Contract Network Specialist

Blue Shield of California Promise Health Plan
10.2018 - 08.2021
  • Lead person for all Region Skilled Nursing Facilities.
  • Manage contracting efforts through the entire procurement process. Ensure contracts are administered and implemented accurately.
  • Lead liaison and subject matter expert for assigned networks that include, rate negotiations, performance measurements, opportunities for increased access and availability of services and strategic planning for long term goals.
  • Negotiate complex non-standard rates according to prescribed guidelines in support of national and local network strategies.
  • Maintain working relationships with various agencies within the industry example of but not limited to CAHF organization.
  • Work with Finance, Actuarial and Legal departments to finalize efficient and financially sound contracts to supplement and enhance network.
  • Assists in preparing financial projections and conducting analysis in coordination with actuarial team along with maintaining accountability for specific medical costs initiatives.
  • Performing Gap Analysis reports and collaborating with Utilization Management to ensure adequate access to specific networks assigned.
  • Responsible for timely and professional interaction with Providers as well as other agencies and escalate recurring or critical issues, such as quality of care or access, and presenting solutions to management in a timely fashion.
  • Oversee and coordinate timely resolution of Provider Claims issues while assessing the root cause and taking appropriate steps to resolve issues long term.

Sr Provider Contract Specialist, Provider Contract Specialist II, Provider Contract Specialist I

Molina Healthcare Inc.
02.2017 - 08.2017
  • Review and configure contracts for consistency in grammar, formatting and guidelines.
  • Assess contract language for compliance with corporate standards and regulatory requirements.
  • Facilitate and resolve template language updates impacting assigned Health plans.
  • Develop and maintain contract templates in Emportis contract management software.
  • Target language updates to ensure proper usage of the templates.
  • Maintain collaborative relationships with Health Plan contacts.
  • Advise leaders on new updated contracts and health plan updates.
  • Collaborate with departments to ensure template updates have been configured properly in Emportis.
  • Participate in management team and committees addressing strategic goals.
  • Partner with Provider Contract Support Service team to compile proper enterprise key terms.
  • Conduct quarterly audits on contract templates to ensure contingency documentation.
  • Serve as the subject matter expert (SME) to the rest of the team and coordinate projects, reviewing team members’ work before releasing the contract template to the appropriate health plan.
  • Provide refresher training and training for new staff.

Finance – Healthcare Analyst I

Molina Healthcare of California
01.2012 - 10.2012
  • Provided analytical and decision support to departments.
  • Performed analysis to identify areas of cost improvement.
  • Prepared reports to meet regulatory requirements.
  • Verified proper consumer-directed health plan payment and timely submission.

Education

Healthcare Administration -

University of Phoenix

General Credits - undefined

California State University of Northridge

Skills

  • Contract Negotiation
  • Medi-Cal & Medicare Regulations
  • Letters of Agreement
  • ICD-9-10, HCPC, and NDC
  • Coding Terminology
  • Contract Management
  • Provider and Customer Relations
  • Contract Template Configuration
  • Regulatory Compliance

Languages

Spanish
Native or Bilingual
English
Full Professional

Timeline

Director of Managed Care

International Equity Partners, Inc
08.2021 - 08.2025

Experience Provider Contract Specialist, Contract Network Specialist

Blue Shield of California Promise Health Plan
10.2018 - 08.2021

Sr Provider Contract Specialist, Provider Contract Specialist II, Provider Contract Specialist I

Molina Healthcare Inc.
02.2017 - 08.2017

Finance – Healthcare Analyst I

Molina Healthcare of California
01.2012 - 10.2012

General Credits - undefined

California State University of Northridge

Healthcare Administration -

University of Phoenix

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YANET OCHOA