Alexia Heath
Manager, Network and Provider Relations @Southwestern Health Resources
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WORK HISTORY
Manager, Network and Provider Relations @Southwestern Health Resources
Dallas, TX, US
The Manager of Network Relations is responsible for managing ACO and Fee for Service payor relationships and resolving complex global payor operational issues on behalf of SWHR Physician Network. In addition, this job is responsible for project management activities related to process workflow enhancements, educating/training SWHR Physician Network on payor agreements/requirements and chairs the Monthly/Quarterly Joint Operating Committee Meetings. This role applies a broad range of knowledge of healthcare, works independently, and provides leadership to the Network Relations team.*Responsible for partnering with the Director of Network Relations to oversee the provider/payor relationships that contribute to the strategic development of the network.*Act as a liaison to managed care partners, Accountable Care Organizations (ACO) and Parent Entities.*Work to resolve issues and build cooperative relationships with a range of payors.*Track and monitor payor compliance with established policies and procedures.*Support providers with contracted MCOs when escalated from provider relations team.*Monitors and drives monthly/quarterly KPIs for Payor efficiency and effectiveness.*Leads monthly Joint Operations Committee Meetings with Managed Care Organizations.*Provides leadership for the Provider/Payor Relations team, including assigning work priorities and maintaining performance standards by coaching employees, performing performance appraisals, recruiting, recommends merit increases and provides required training.*Implements and communicates policies and procedures in payor relations with a focus on process improvement to help eliminate redundancies.*Responsible for implementing internal processes and procedures to meet and satisfy all regulatory and policy requirements including updates to Payor Resources for team.*Ensure regulatory compliance for contracted MCO, ACO, CMS Medicare, Medicaid and enrollment.
EDUCATION
Northeast Texas Community College
Associate of Science (A.S.), Business Administration and Management, General
Strayer University
Master of Business Administration (M.B.A.), Business Administration and Management, General
University of Texas at Tyler
Bachelor of Business Administration (B.B.A.), Business Administration and Management, General
ABOUT ALEXIA HEATH
Experienced Executive with a demonstrated history of working in the hospital & health care industry. Skilled in Medicaid, Medicare, Claims Resolution, Account Management, Managed Care, Contracting, Behavioral Health, and TRICARE. Strong business development professional with a Master of Business Administration (M.B.A.) focused in Business Administration and Management, General from Strayer University.
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