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Danny Roman
2517 St. Raymond Avenue, Bronx, New York 10461
347-831-5916
Dino2peb@aol.com
Objective Provider Relations / Contracting
Profile Over 12 years experience as provider relations representative.
Ability to negotiate contracts and recruit providers to expand networks.
Goal-oriented individual with strong leadership capabilities.
Organized, highly motivated, and detail-directed problem solver.
Proven ability to work with physicians, their office staff, and internal departments.
Relevant Experience & Accomplishments
Provider Relations
Educate providers on STARS, Hedis and RAF scores
Successfully recruited and expanded provider network. / ACO recruitment
ACO education and recruitment
Conducted orientations for Primary Care Physicians and specialists group and hospitals.
Perform site surveys.
Informed providers about policy and regulation changes.
Developed relationships with physicians that assisted with sales growth.
Monitor high volume providers on membership growth.
Identified potential claim trends and resolved claim issues.
Negotiated contracts with providers and health centers, hospitals and behavioral health facilities’
FIDA education and recruitment
MLTC education to nursing homes, transportation providers, adult day care centers and meals on wheels.
Management/Supervision
Coordinated staff of four people operations.
Educated physicians about network and policy/procedures for plan.
Network Account Manager / Visiting Nurse Services New York, NY
Educate providers on Policy and Procedures / STARS, HEDIS
Provider Contracting / Provider Education Consultant, Healthcare Partners IPA,
Garden City, NY
Educate physicians on policy and procedure, negotiate contracts and recruit
Network Physician Contractor, United HealthCare, New York, NY
Contract providers to build network need and expand growth
Network Management & Contracting Representative, Healthfirst Inc., NY
Recruit providers and negotiate contracts.
Conduct provider orientation and site surveys.
Identify claim trends and resolve claim issues with internal department.
9/2014 -Present
3/2011- 9/2014
6/2009 - 3/2011
4/2003-11/2008
Senior Provider Relations Representative, Fidelis Care Rego Park, NY
Credentialed providers upon submission of application.
Contracted providers and Article 28 health centers.
3/1998-4/2003

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Danny Roman Resume 2015

  • 1. Danny Roman 2517 St. Raymond Avenue, Bronx, New York 10461 347-831-5916 Dino2peb@aol.com Objective Provider Relations / Contracting Profile Over 12 years experience as provider relations representative. Ability to negotiate contracts and recruit providers to expand networks. Goal-oriented individual with strong leadership capabilities. Organized, highly motivated, and detail-directed problem solver. Proven ability to work with physicians, their office staff, and internal departments. Relevant Experience & Accomplishments Provider Relations Educate providers on STARS, Hedis and RAF scores Successfully recruited and expanded provider network. / ACO recruitment ACO education and recruitment Conducted orientations for Primary Care Physicians and specialists group and hospitals. Perform site surveys. Informed providers about policy and regulation changes. Developed relationships with physicians that assisted with sales growth. Monitor high volume providers on membership growth. Identified potential claim trends and resolved claim issues. Negotiated contracts with providers and health centers, hospitals and behavioral health facilities’ FIDA education and recruitment MLTC education to nursing homes, transportation providers, adult day care centers and meals on wheels. Management/Supervision Coordinated staff of four people operations. Educated physicians about network and policy/procedures for plan. Network Account Manager / Visiting Nurse Services New York, NY Educate providers on Policy and Procedures / STARS, HEDIS Provider Contracting / Provider Education Consultant, Healthcare Partners IPA, Garden City, NY Educate physicians on policy and procedure, negotiate contracts and recruit Network Physician Contractor, United HealthCare, New York, NY Contract providers to build network need and expand growth Network Management & Contracting Representative, Healthfirst Inc., NY Recruit providers and negotiate contracts. Conduct provider orientation and site surveys. Identify claim trends and resolve claim issues with internal department. 9/2014 -Present 3/2011- 9/2014 6/2009 - 3/2011 4/2003-11/2008 Senior Provider Relations Representative, Fidelis Care Rego Park, NY Credentialed providers upon submission of application. Contracted providers and Article 28 health centers. 3/1998-4/2003