Manager, Provider Data and Credentialing @ Centene Corporation
Manager, Business Operations @ Centene Corporation
Bachelors, Human Resource Management @
Loyola University Chicago
Director, Provider Data Management @ Responsible for Provider Contract Loading, Credentialing and Provider Directory functions for the Centene Subsidiary that is serving over 2 million members. From December 2013 to June 2015 (1 year 7 months) Austin, Texas AreaManager, Provider Data and Credentialing @ From June 2012 to December 2013 (1 year 7 months) Manager, Business Operations
Director, Provider Data Management @ Responsible for Provider Contract Loading, Credentialing and Provider Directory functions for the Centene Subsidiary that is serving over 2 million members. From December 2013 to June 2015 (1 year 7 months) Austin, Texas AreaManager, Provider Data and Credentialing @ From June 2012 to December 2013 (1 year 7 months) Manager, Business Operations @ Lead a New Business Implementation Team in Benefit and Pricing configuration business requirements development. From March 2012 to June 2012 (4 months) Manager, Corporate Encounters @ From June 2011 to March 2012 (10 months) Greater St. Louis AreaHealth Plan and Financial Reporting Mgr, Chief of Staff to Corp VP Business Ops @ From October 2010 to November 2011 (1 year 2 months) Manager, Claims Business Performance @ • Managed and mentored two Claims Business Analysts.
• Managed the Claims Analysis report automation and migration process to an enhanced business intelligence platform while working with Corporate and Health Plan leadership.
• Created and managed Claims Operations Annual Administration Budget in excess of $20M and 400 employees. From September 2009 to October 2010 (1 year 2 months) Corporate Manager, Network Administration and Operations @ • Lead a team of three Business Analysts in the development and deployment of the Corporate Contracting Lifecycle Metrics which includes the Contracting, Credentialing, Provider Data, Provider Reimbursement and Configuration departments and serves over 1.2 million Medicaid members.
• Supported New Business network development through the creation of tools to facilitate network development strategies for new market entry, coordinating the submission of contract boilerplates and marketing materials for approval, providing metrics to manage the provider contract process and creating network filings for state regulator approval.
• Leveraged web based technology to create and deploy dashboards for rapid operational issue recognition and process compliance.
• Created policy and process documentation where needed in the Network Management Plan. From June 2008 to September 2009 (1 year 4 months) Corporate Manager, New Business Contracting @ • Served as the New Business Contracting Field Support leader for new Centene subsidiary companies.
• Served as the Contracting Subject Matter Expert for Request for Proposal responses.
• Developed and implemented network development strategies for new market entry, managed the provider contract negotiator support process, oversaw the state submissions for contracts and marketing material, provided oversight to the contract administration function, created state submission for regulatory approval for multiple markets.
• Developed and implemented process measures, standards and reports for New Business to manage and improve the contracting process while identifying and managing the legal, financial and operational risks. From November 2007 to May 2008 (7 months) Corporate Manager, Contracting @ • Served as the New Business Contracting Field Support leader for new Centene subsidiary companies and the Network Optimization leader for all Centene subsidiary companies. Implemented a corporate wide facility contract forecasting and monitoring program; Contract and Provider Data Management timeliness monitoring program and the Contracting Inter plan communication forums for monitoring report definition, information sharing and best practice migration across the contracting enterprise.
• Developed and implemented network development strategies for new market entry, supported the field negotiation team while providing oversight to the contract management and implementation process for state filings. From August 2006 to November 2007 (1 year 4 months) Network Development Manager @ Market Manager of Network Development, Biloxi, MS
• Managed three Network Development Supervisor teams which were remotely located in Mississippi, Alabama, Tennessee, Southeast Louisiana and the Florida Panhandle in contract negotiations and provider education for a 650,000 lives HMO, PPO and Traditional network.
• Successfully developed and implemented network contracting strategies, audited contract implementation and steerage to ensure compliance with Medical Expense Ratio goals. Improved SG&A performance with stringent budgetary oversight and process improvement while exceeding company annual incentive objectives. From May 2004 to August 2006 (2 years 4 months) Network Development Manager @ Manager of Network Development, Chicago, IL
• Provided the indirect leadership of a team of six professional which were located in five sites in the contracting and educating of hospital, ancillary and professional providers for a 75,000 lives HMO, PPO and Indemnity network in Wisconsin, Illinois and St. Louis, Mo.
• Developed and implemented the network development strategy to ensure compliance with company MLR targets. Assisted Service Center Managers by serving as the technical mentor to the Provider Relations Representatives. From January 2002 to May 2004 (2 years 5 months) Consultant - Brand Protection and Financial Services @ • Worked with Plan executives in the data collection, financial analysis and periodic reporting of individual plan performance in accordance with the BCBSA licensee requirements and the following benchmarks: Capital and Surplus, MCO-RBC, Liquidity, Enrollment, Utilization and Service.
• Managed the departmental User Group in identifying additional system needs, developing business plans and coordinating with both employees and contracted programmers in the creation, implementation and testing of new system modifications that allowed for successful data collection of Plan data. From September 2000 to December 2001 (1 year 4 months) Network Consultant - TRICARE (contract bought from HCSC) @ From May 2000 to September 2000 (5 months) Chicago, ILNetwork Consultant - TRICARE @ From May 1998 to April 2000 (2 years) Supervisor - Medicare Collections and Reimbursement @ From 1997 to 1998 (1 year) Brokerage Administration Coordinator @ From 1996 to 1997 (1 year) Fort Dearborn Life Administration @ From 1995 to 1996 (1 year) Reinsurance Claims Analyst @ From 1993 to 1995 (2 years)
MBA, Finance @ Keller Graduate School of Management of DeVry University From 2005 to 2010 Bachelors, Human Resource Management @ Loyola University Chicago From 1995 to 1998 Associates, Finance @ Harold Washington College From 1993 to 1995 Fairleigh Dickinson University From 1988 to 1991 Mark L. Smith, MBA,FAHM is skilled in: Managed Care, Network Development, Medicaid, Healthcare, Provider Relations, Process Improvement, Health Insurance, Strategic Planning, Department Budgeting, Encounters, Staffing Models, Dashboard Metrics, Network Administration, Provider Data Management, Incentive Compensation..., Analysis, Budgets, Business Analysis, Business Process..., Contract Negotiation, Credentialing, Forecasting, HIPAA, HMO, Healthcare Management, Leadership, Management, Team Building, Health Policy, Six Sigma, Healthcare Information..., Hospitals, Program Management, Financial Analysis, Policy, Business Intelligence, Software Documentation, Medicare, Incentives
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