Jerryleneq John

Senior Member Success Manager

Led and developed a team of five customer-facing professionals, redesigned the client onboarding program, and managed customer escalations to ensure successful client outcomes.

Team LeadershipCoachingPerformance ManagementMentorshipClient OnboardingCustomer Escalation ManagementProcess Improvement

Lead Vendor Management Analyst

EmblemHealth

Served as primary relationship manager for leased network vendor partnerships, managed vendor performance and contract compliance, and led resolution of escalated provider and member issues.

Vendor ManagementContract CompliancePerformance ManagementData AnalysisNegotiationStakeholder ManagementExecutive Reporting

Contract Development Manager

Negotiated contract language and fee arrangements for 11 clients, launched the Alternate Level of Care program, and led development of HARP, FIDA, and Residential Redesign initiatives.

Contract NegotiationProgram DevelopmentUtilization ReportingProvider ContractingNetwork DevelopmentCompliance

Senior Network Management Representative

Initiated, negotiated, and generated physician and multi-specialty contracts, and led provider education on coding best practices to enhance HEDIS scores.

Contract NegotiationProvider RelationsProvider EducationHEDISCompliance

Network Management Representative

Increased physician network by developing relationships with new providers, and conducted quarterly meetings with consultants and physicians to manage medical cost trends.

Network DevelopmentProvider RelationsData AnalysisCost Management

Provider Relations Representative

Performed network recruitment and developed contract arrangements, and managed a high volume of inquiries, claims appeals, and grievances.

Provider RelationsContract DevelopmentClaims ManagementGrievance Resolution

Provider Operations Coordinator

Provided project management, provider recruitment, data analysis, and administrative support, and audited provider database for accuracy.

Project ManagementData AnalysisProvider RecruitmentDatabase AuditingAdministrative Support