Teams at PacificSource Health Plans

Lead Provider Network Operations overseeing provider relations, credentialing, data management, platform interoperability, and compliance. Drive strategic initiatives, vendor and IT partnerships, automated workflows, LEAN improvements, budgeting, staff development, and performance monitoring across Medicaid, Medicare, and Commercial lines of business.

Audit and reconcile enrollment, billing, and accounts receivable across lines of business. Develop and test reports, support configuration and interface changes (including 834 files), validate ACH/lockbox transactions, resolve enrollment/eligibility issues, maintain procedures and tracking tools, and recommend process improvements to ensure data integrity and compliance with Federal and State Exchange guidelines.

Manage and grow a block of complex employer group accounts (51+ lives), lead renewals and RFP responses, consult on benefits strategy, coordinate implementations, liaise with brokers and vendors, identify cross-sell opportunities, and provide ongoing client service while traveling frequently.