1. TONYA L. DAVIS
1686 Jackson Square Atlanta, Georgia 30318 (404) 808 1268
email: tldavis70@yahoo.com
ACCOMPLISHMENTS: Developed Physician and Ancillary Networks for start up plans in 7 states for Managed
Medicaid Health Plans. Lead Negotiations for Medicaid Medicare Duals Demonstration and Healthcare Exchange products while
simultaneously renegotiating Medicaid rates for existing Providers. Maintained rate proposals within health plan standards to meet
and exceed accessibility standards, quality and financial targets. Successfully converted Letters of Intent and Letters of Agreement
to negotiated and executed contracts.
EXPERIENCE:
March 2008 to Present Centene Corporation, St. Louis, Missouri
Provider Network Development Manager
Support the Provider Network Development activities related to new products or new
business opportunities. Contract and Recruit Primary Care Physicians, Specialists and
Ancillary Providers for a Managed Medicaid Health Plan in new markets. Manage
Physician network recruitment in new business product initiatives. Develop and implement
tools, standards, and process for network development initiatives. Responsible for
negotiating rate and contract language for Healthcare Exchange and Medicare Advantage
contracts in existing markets. Recruit and contract with specialties needed to meet
geographical access standards in new and existing markets. Negotiate and renegotiate
provider contracts in accordance with health plan standards in order to maintain or enhance
provider networks while meeting and exceeding accessibility and financial goals.
February 2006 to March 2008 Amerigroup Corporation, Atlanta, Georgia
Director, Provider Relations
Managed a staff of 14 Provider Relations Representatives and Hospital Account Managers.
Responsible for the contracting and recruitment of Physicians, Hospitals, and Ancillary
Providers for a statewide Managed Medicaid health plan. Responsible for the oversight
and management of the health plan’s credentialing sub committee. Ensured the health
plan’s programs for provider credentialing, orientation, education and services were
appropriate and met the corporate standards as well as those of the Department of
Community Health. Responsible for leading and managing all aspects of provider
implementation. Responsible for maintaining necessary provider service standards and
facilitating necessary marketing programs which involve providers. Oversight and
management of the PCP Quality Improvement Program, including ensuring results are
clearly communicated to the provider community and consistent improvement in provider
performance is achieved. .Responsible for supporting strategic network composition and
design initiatives which are consistent with the objectives of the health plan. Oversight and
management of creating the NCQA Provider Services Templates for accreditation.
August 2001 to August 2005 Children’s Healthcare of Atlanta, Atlanta, Georgia
Manager, Provider Relations The Children’s Health Network(TCHN)
Responsible for recruitment, credentialing and contracting of pediatricians and pediatric
sub-specialists within the Physician Hospital Organization. Managed two External
Provider Relations Specialists. Coordinated education and professional development
seminars for practice administrators. Implementation and education of provider
contracts.
Provider Services Supervisor The Children’s Health Network(TCHN)
Responsible for overseeing the provider recruitment and contracting with the Physician
Hospital Organization. Supervises two external Provider Relations Representatives and one
Internal Provider Relations Representative. Facilitates quarterly meetings with other
Managed Care Organizations.
Provider Relations Representative The Children’s Health Network(TCHN)
Served as liasion between the physicians and the contracted managed care payors as well as
providing recruiting and contracting functions for the Physician Hospital Organization.
Performed physician office site visits in accordance with National Committee for Quality
Assurance standards and maintained a detailed log of completed visits and practice data.
2. Proactively supported the efforts to ensure delivery of safe patient care and services and to
promote a safe environment at Children’s Healthcare of Atlanta.
September 2000 to August 2001 Promina Health System, Atlanta, Georgia
Provider Relations Representative
Responsible for maintenance of Provider Network through onsite visits and inservice
education.
Developed education and training materials for participating providers. Served as the
conduit for contracted capitated payors such as CIGNA Healthcare of Georgia, One Health
Plan of Georgia, and Aetna US Healthcare and various HMO , POS and PPO plans. Acted
as the liasion between Local Integrated Delivery Systems (LIDS) and Promina Health
System(PHS) to address claims and various network operational concerns. Assist in the
strategic analysis of PHS markets to determine the opportunity for developing physician
networks. Additionally Developed provider guides for PHS and network physicians
September 1998 to June 2000 One Health Plan of Georgia, Atlanta, Georgia
Provider Relations Assistant
Responsible for supporting providers to ensure cost effective, high quality care and
service to HMO, POS, and PPO members. Utilized efficient management and
organizational skills to track provider inquiries for problem resolution, identify and
report trends, and maintain provider handbook and database. Served as a liaison
between provider, Benefit Payment Office, and database management areas and
supported credentialing function. Additionally, contracted ancillary providers,
conducted office site visits and orientations for Primary Care Physicians, worked closely
with sales offices and brokers to recruit physicians for the network and completed two
courses on the Fundamentals of Health Insurance from the Health Insurance Association
of America.
April 1996 to February 1998 Prudential HealthCare Co., Atlanta, Georgia
Account Specialist
As a valuable team member of the Marketing Department, communicated effectively
and efficiently to service client details and resolve problems. Utilized solid presentation
skills and comprehensive research to assist in the acquisition of new clients and conduct
enrollment meetings.
Member Services Representative
Responsible for educating members about healthcare polices and systems and providing
assistance in utilizing healthcare plan services and available resources. Utilized creative
problem solving to identify, discuss, and recommend appropriate solutions to member’s
problems and issues. As liaison between members and Prudential, utilized effective
verbal and written communication skills to identify areas of improvement for the
company and effect change.
October 1993 to December 1994 CIGNA HealthCare Corporation, Bloomfield, Connecticut
Prescriptions, Appeals, Correspondence, Eligibility (PACE) Representative
Assumed direct responsibility for analyzing appeals and making judgement decisions
on the reimbursement of money paid on claims. Communicated benefits to Healthcare
providers, members, policyholders, sales, claims, and Health plan partners. Also
processed and resolved complaints and grievances regarding Healthcare providers.
Customer Service Representative
Answered inquiries from members, providers, policy holders, sales, and others
regarding health plan benefit services and status on related inquiries accurately,
promptly, and courteously. Educated customers on administration procedures.
Maintained professional attitude to promote good customer relations and teamwork.
EDUCATION: HAMPTON UNIVERSITY, Hampton, Virginia
Degree: Bachelor of Science, Marketing
