Melissa Ochoa CELL: 954-529-7224 OMELISSA77@YAHOO.COM PROFESSIONAL EXPERIENCEProvider Operations Contract Negotiator – Miami Dade & Monroe CountyCommunity Care Plan – August 2023 Ð Present ¥Negotiate contracts with hospitals, physicians, specialists, and ancillary providers to secure competitive reimbursement rates and favorable terms. ¥Draft and amend agreements and addendums with legal counsel, ensuring alignment with Medicaid and organizational requirements. ¥Conduct reimbursement and fee schedule analysis to support cost-saving strategies and competitive positioning. ¥Expand provider network through onboarding new physician groups and specialists to meet Medicaid access and adequacy standards. ¥Service as the primary contact for provider contract inquiries, issue resolution and service related needs. ¥Lead provider trainings on contract terms, operational expectations and policy updates. ¥Develop utilization and trend reports that support negotiation strategy and overall organizational goals. ¥Collaborate with Finance, Compliance, and Operations to ensure contracts support regulatory, strategic and Þnancial initiatives. ¥Maintain up to date knowledge of healthcare reform, value-based care and regulatory changes. Provider Operations Representative – West Broward County Community Care Plans Ñ August 2022 Ð August 2023 ¥Conduct on-site visits to educate physicians and practice managers on compliance, coding and encounter data accuracy.¥Implemented action plans to improve performance among underperforming providers. ¥Supported network growth and engagement efforts with physicians and hospital systems.¥Organized of Þce manager meetings to improve communication, compliance, and operational work ßow. ¥Ensured alignment with Medicaid, NCQA and Pay for Performance requirements. ¥Resolve provider issues, track performance, and develop action plans for non-compliant providers. System Data Coordinator Community Care Plans Ñ July 2021 Ð August 2022 ¥Managed provider master data in Epic Tapestry, ensuring demographic accuracy and compliance with network requirements. ¥Coordinated demographic updates and credentialing changes with vendors and provider of Þces. ¥Maintained internal data work ßows to support claims processing, reporting accuracy and regulatory compliance. EDUCATIONUniversity of North Carolina at Chapel Hill Paralegal Certi Þcate , December 2019 Florida State University, Tallahassee, FLBachelor of Arts, Criminal Justice , 2014 SKILLS¥Languages : Fluent in English and Spanish ¥Typing Speed : 61 WPM ¥Systems: Epic Tapestry, Salesforce, Athena, Allscripts, CAQH, NPPES, Sunbiz¥Software: Microsoft Excel, Word, PowerPoint, Outlook PROFESSIONAL ATTRIBUTES¥Strong negotiation, communication and relationship-building skills¥Organized, self-driven, and adaptable in Þeld, clinical and of Þce settings ¥Detail-oriented with high integrity and commitment to improving patient outcomes¥Comfortable managing multiple priorities and fast paced workloads
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