Annette Flores

Experience

• 

  Hacienda Inc.

  Jan 2001 - Jan 2002

  Assistant Synagis Program Coordinator

  Managed verification of insurance and authorization, appointment reminders, interfaced with physicians and patients, and troubleshot insurance issues.

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  Hacienda, Inc

  Feb 2002 - Mar 2003

  Service Support Coordinator

  Managed distribution of medical supplies, verification of insurance and authorization, maintained patient records, and provided billing support.

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  Hacienda, Inc.

  Apr 2003 - Apr 2006

  Created and managed Requests for Proposals (RFP), Requests for Quotation (RFQ) and OASIS forms. Managed patient medical records to comply with state and federal guidelines. Managed controlled system to ensure accurate contract pricing for invoices.Provided billing support; generated reports and analysis regarding customers, supplier(s) and contract pricing.

  • Assistant Director of Business Operations

    Sept 2005 - Apr 2006

  • Internal Operations Manager

    Apr 2003 - Aug 2005
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  DJO

  May 2006 - May 2008

  Payor Development Specialist

  Managed the entire contract life-cycle to include: initiation, credentialing, negotiation, and implementation of fully-executed contract.Generated and distributed contract fact sheets and reports to field staff and departments regarding updated information on our providers.Managed contractual issues, completion of credentialing and re-credentialing applications.Developed and implemented contract policies and procedures.Performed outreach activities with potential and contracted providers to maintain or initiate contact with providers. Show less

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  Coventry Health Care

  Jan 2009 - Apr 2009

  Provider Contracting Specialist

  Maintained managed care agreements with physicians and ancillary providers pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers’ compensation. Recruited individual providers who met established selection criteria to assure adequate geographic and specialty coverage. Developed and implemented a formal documented program to ensure good communication with physicians and ancillary providers. Generated and analyzed reports regarding the provider network. Show less

• 

  Tivity Health

  Jul 2009 - Nov 2020

  100% remote work environment, covering three time zones. Contacted potential fitness partners, determined suitability, and clearly presented/demonstrated the benefits of being a Tivity Health fitness network partner.• Followed up by email or phone with potential partners, negotiated contract terms (if necessary) and obtained a signed agreement.• Prepared presentation emails and contracts to potential partners.• Reviewed effectiveness and implemented improvements for potential partner recruitment procedures.• Maintained fitness partner presentation and training materials.• Aided in development of new role and responsibilities.• Developed templates and materials for standard and new initiative recruitment.• Traveled to targeted areas for in-person recruitment and scouting for potential fitness partners (20% travel). • Maintained a detailed and organized tracking system for fitness partner recruitment. • Assisted with additional contract, payment, or reporting issues for the contracted fitness partners. Show less Processed contracts, amendments, assignment documents, insurance certificates and other documents into the database in accordance with standard protocol.• Tracked and communicated processing status within the department.• Maintained a database of contract terms, customizations, and contractual obligations to allow for efficient management of contracts.• Ensured data integrity by developing and performing quality assurance procedures related to fitness provider information, including data verification and validation.• Communicated fitness partner network modifications throughout the company through formal updates and reports.• Ensured fitness partners remain in compliance with the terms of their contract agreement with regard to providing insurance certificates; pursue and obtain appropriate evidence of insurance when necessary.• Organized and maintained Tivity Health provider contracts.• Resolved provider data issues.• Prepared contract-related correspondence. Show less Analyzed market network needs; developed and implemented strategies to meet those needs.• Interacted with current, new, and prospective clients to ensure network expectations are understood, communicated, and implemented.• Coordinated network changes with Contracts, Account Management, Marketing, and all other appropriate departments to ensure Tivity Health’s business needs are met.• Maintained membership information integrity in accordance with HIPPA regulations and Tivity Health policies and procedures.• Performed demographic data analysis, report, created strategies, and implemented projects/activities regarding Medicare-eligible population concentrations (CMS data), major ethnic populations and their geographic concentrations, "invisible barriers".• Created special reports for specific markets• Designed, documented, and implemented or recommended process improvements.• Maintained constant communication with other Tivity Health departments to ensure clear communication and operational efficiency.• Managed network development in current, new, and prospective markets by directing and tracking progress of all ND activity Show less Maintained and reported evidence of insurance for all contracted Tivity Health partnered locations. • Assisted with accurate data entry of evidence of insurance for fitness partner network accessibility, cost of sales and provider retention. • Provided weekly reports of locations not compliant with evidence of insurance.• Sent and tracked reminder letters at all levels of insurance compliance• Processed contract and location terminations on a timely basis in support of network accessibility and accurate measurement of cost of sales. Show less

  • Fitness Network Development Specialist

    Jul 2011 - Nov 2020

  • Contract Coordinator

    Sept 2010 - Jul 2011

  • Network Development Analyst

    Mar 2010 - Sept 2010

  • Compliance Specialist

    Jul 2009 - Mar 2010
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  Magellan Health

  Mar 2021 - Jul 2022

  Operations Specialist

  • Operational management of assigned book of business to achieve profitable retention of accounts.• Responsible for timely and accurate maintenance of operational records and information in multiple databases. • Researches and resolves questions and complaints and ensures that information in all databases is accurate and properly configured to support operations.• Ensures Service Level Agreement performance. Documents and maintains required reporting• Owns overall internal account satisfaction within the company as well as satisfaction with each support area particularly account management.• Develops and maintains multi-level relationships within client organizations which includes maintaining contract requirements.• Communicates and updates account service information to appropriate internal staff. Makes presentations to the professional community to enhance the visibility and image of the company.• Supports the account management team to ensure performance standards are measurable and realistic to achieve and/or exceed to avoid penalties. Manages methodology, reporting and communications.• Resolves or appropriately escalates customer service issues in conjunction with operations (claims, service, and systems).• Coordinates with the compliance department on knowing and understanding state and federal regulations and the implication to customer impact.• Prepares and supports presentations of customer reports with meaningful analytics, trending and recommendations for program improvement based on findings.• Identifies products and services that bring solutions to the customer based on a thorough understanding of the customer's strategic business goals and the business needs. Show less

• 

  HIMSS

  Jul 2022 - now

  Senior Provider Relations Specialist

  •Contributed to the strategic growth of HIMSS by increasing individual members, OA clients, and OA revenue by ensuring OA clients have a satisfactory experience. •Ensured OA clients and their employees were taking advantage of program benefits and opportunities.•Accountable for growth in program benefits, provided oversight and day-to-day management on behalf of HIMSS, and supplied clients with timely responses regarding benefits, product information, services, pricing, and company information.•Acted as liaison between OA clients and HIMSS staff with the OA registration process for the global conference (in-person and digital) and virtual events, including all reporting requirements. •Collaborated with other HIMSS teams on Distance Education issues, collaborated with IT Department to provide support for testing and system upgrades/enhancements, and new feature implementations.•Managed client renewal agreements by analyzing benefit usage to determine appropriate actions to encourage clients to maximize the use of OA benefits or provide upgrade options. •Ensured OA client satisfaction by analyzing individual client satisfaction ratings and feedback to maintain high program value and service levels.•Managed all membership-related tasks for assigned clients (signing up members, converting members, submitting refunds, terminating members who are no longer with OAs, processing batch renewals, activating Primary Contacts, etc.).•Provided on-site support to OA clients and assisted with on-site activities at global conferences including but not limited to staffing the Executive Summit, helped with special events, participated in new member events, staffed HIMSS Spot, and attended chapter-related events.•Shared admin responsibilities for the OA Spot on Accelerate and monthly newsletter. Created posts in the group, reviewed requests to join and promoted the group to assigned clients to increase sign-up and usage of the group. Show less