Samuel Bradley
San Jose
Summary
Results-driven Provider Network Manager with expertise in strategic planning, project management, and performance improvement. Proven ability to enhance provider relationships and drive organizational initiatives.
Overview
20
20
years of professional experience
Work History
Provider Network Manager
San Francisco Health Plan
10.2023 - Current
- Provider relationship management.
- Serve as a primary point of contact for delegated medical groups, vendors and ancillary providers
- Identify trends and share at a strategic level
- Drive performance and improvement with assigned network
- Contribute to network strategy, planning and organizational initiatives
- Cross-Functional collaboration with claims, operations, credentialing and compliance.
- Support end-to-end operations and delegated oversight functions
- Manage multiple projects, initiatives and timelines simultaneously
- Support ECM, claims workflows and data-driven performance tracking
Contract Manager
Beacon Health Options (Carelon)
Cerritos
03.2016 - 11.2022
- Developed autism network for west region, enhancing provider retention through strategic recruiting
- Develop the Medicaid network for mild to moderate benefits.
- Negotiate reimbursement rates in key markets.
- Reviewed and edited agreements for healthcare facilities to ensure compliance.
- Control costs through the development of value-based reimbursement.
- Complete audits for California Department of Managed Healthcare (DMHC).
- Present quarterly network updates to health plan partners.
Physician Services Rep II
Brown & Toland Physicians
Oakland
02.2013 - 04.2015
- Cultivated strong relationships with assigned physicians in ophthalmology, cardiology, and gastroenterology to enhance collaboration.
- Educated 150+ specialists on reimbursement models, including capitation, fee-for-service, and pay-for-performance to improve understanding of financial processes.
- Provide training and support for the preferred provider network with on electronic health record .
- Onsite Field Visits across San Francisco and San Mateo County.
- Educated assigned providers on the Performance Improvement Plan (PIP) to enhance quality of care.
Marketing Assistant
Brown and Toland Physicians
09.2012 - 12.2012
- Assist with new marketing initiatives during MAPD open enrollment
- Sell the Brown & Toland network to commercial HMO members as well as Medicare Advantage Beneficiaries.
- Work with broker partners in registering members for Medicare Advantage
Service Consulant
United Health Group
Phoenix
10.2006 - 09.2011
- Managed large self-funded group in the public sector
- Addressed client and member issues regarding claims, eligibility, prior authorizations, and appeals to improve satisfaction.
- Managed escalated issues related to claims, eligibility, and authorization requests to ensure timely resolutions.
- Provided on-site customer service support to address inquiries and resolve issues.
- Enhanced account retention by hosting benefit fairs to explain plan design and promote ancillary services.
- Held open enrollment meetings for self funded and fully insured groups
- Attended open enrollment meetings and benefit fairs for Medicare Advantage
Education
Some College (No Degree) - Sociology
Arizona State University
Tempe, AZSkills
- Provider management
- Network strategy
- Network development
- Performance improvement
- Contract negotiation
- Customer relationship management
- Data analysis
Timeline
Provider Network Manager
San Francisco Health Plan
10.2023 - Current
Contract Manager
Beacon Health Options (Carelon)
03.2016 - 11.2022
Physician Services Rep II
Brown & Toland Physicians
02.2013 - 04.2015
Marketing Assistant
Brown and Toland Physicians
09.2012 - 12.2012
Service Consulant
United Health Group
10.2006 - 09.2011
Some College (No Degree) - Sociology
Arizona State University