Daphanie Dean
Columbia
Summary
Corporate leader with extensive experience in strategic planning, business development, and operational management. Strong focus on team collaboration and achieving measurable results. Adaptable with proven track record in leading cross-functional teams, optimizing processes, and driving organizational growth. Skilled in stakeholder engagement, financial oversight, and change management.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Corporate Director, Managed Care
Medical University of South Carolina (MUSC) Health
05.2022 - Current
- Responsible for developing, enhancing, and maintaining new and existing managed care contracts between MUSC Health providers (Acute Care Hospitals, Physicians, and Ancillary providers) and managed care payors, including Commercial, Medicaid, and Medicare managed care plans
- Negotiate competitive reimbursement for healthcare services
- Create a managed care strategy consistent with the strategic plan for the health system
- Collaborate with internal finance and revenue cycle leaders to identify and resolve payer issues, ensuring payers comply with the negotiated contract terms.
- Develop proformas for prospective service expansion across MUSC Health
- Direct activities related to value-based purchasing, population health, and quality initiatives
Director, Managed Care Contracting
Community Health Systems
07.2017 - 05.2022
- Negotiated managed care agreements (fee-for-service and value-based) and facilitated the market-by-market strategy for employed physicians in NC, PA, and WV
- Optimized payer reimbursement and expanded managed care network opportunities for over ninety corporate-owned clinic entities across three states, which generated over $120 million in annual net revenue.
- Tracked clinic participation in value-based care programs, monitored performance, and reported end-of-the-year results to senior leaders.
- Coordinated with C-suite level executives, division leaders, and operational staff to execute managed care agreements, develop strategic business partnerships, and implement commercial and government value-based quality, pay-for-performance, and accountable care programs
- Lead meetings to discuss new business development opportunities and population health initiatives. Correctly identified competitive threats, produced annual strategic plans, and analyzed financial models.
Manager, Physician Contracting
Community Health Systems
10.2012 - 06.2017
- Negotiated managed care agreements (fee-for-service and value-based) and facilitated the market-by-market strategy for employed physicians in NC, PA, and WV
- Optimized payer reimbursement and expanded managed care network opportunities for over ninety corporate-owned clinic entities across three states, which generated over $120 million in annual net revenue.
- Tracked clinic participation in value-based care programs, monitored performance, and reported end-of-the-year results to senior leaders.
- Coordinated with C-suite level executives, division leaders, and operational staff to execute managed care agreements, develop strategic business partnerships, and implement commercial and government value-based quality, pay-for-performance, and accountable care programs
- Lead meetings to discuss new business development opportunities and population health initiatives. Correctly identified competitive threats, produced annual strategic plans, and analyzed financial models.
Senior Network Account Manager
United Healthcare
01.2008 - 01.2012
- Managed all facets of the service and contractual relationship between United Healthcare and in-network physician practices across North and South Carolina for the Commercial, Medicare, and Medicaid lines of business
- Developed and executed negotiation strategies that directly impacted the financial performance of the regional health plan
Internal Auditor
Prisma Health
01.2007 - 01.2008
- Performed operational audits, investigations, and other assigned auditing services in accordance with professional auditing standards to improve the effectiveness of risk management, internal control, and governance processes
- Coordinated and implemented billing-compliant procedures to optimize Medicare, Medicaid, TRICARE, and Commercial payer reimbursement and target front-end and back-end revenue cycle issues to assist in the reduction of AR days
- Managed the HIPAA and billing compliance oversight/monitoring functions for the Patient Financial Services department while maintaining knowledge of current federal, state, and corporate policies
Compliance Manager
Prisma Health
01.2006 - 01.2007
- Performed operational audits, investigations, and other assigned auditing services in accordance with professional auditing standards to improve the effectiveness of risk management, internal control, and governance processes
- Coordinated and implemented billing-compliant procedures to optimize Medicare, Medicaid, TRICARE, and Commercial payer reimbursement and target front-end and back-end revenue cycle issues to assist in the reduction of AR days
- Managed the HIPAA and billing compliance oversight/monitoring functions for the Patient Financial Services department while maintaining knowledge of current federal, state, and corporate policies
Provider Relations Ombudsman
Palmetto GBA
01.2004 - 01.2006
- Educational resource to Home Health and Hospice providers relating to Centers for Medicare and Medicaid Services (CMS) regulations on billing and reimbursement policies
- Designed, delivered, and evaluated the success of face-to-face and web-based training courses for the TRICARE for Life claims and customer service departments
- Analyzed correspondence and formulated responses to third-party payor inquiries from beneficiaries, attorneys, and insurers. Adjusted claims and issued demands for repayment
Education
Doctor of Health Administration -
Medical University of South Carolina
Charleston, SCMaster of Health Administration - undefined
Ohio University
Athens, OHBachelor of Arts - Biology
Hampton University
Hampton, VASkills
- Organizational leadership
- Ethics and integrity
- Operations management
- Strategic partnerships
- Revenue growth
- Teamwork and collaboration
- Problem-solving
- Excellent communication
Certification
Six Sigma Lean Yellow Belt
Telehealth
Timeline
Corporate Director, Managed Care
Medical University of South Carolina (MUSC) Health
05.2022 - Current
Director, Managed Care Contracting
Community Health Systems
07.2017 - 05.2022
Manager, Physician Contracting
Community Health Systems
10.2012 - 06.2017
Senior Network Account Manager
United Healthcare
01.2008 - 01.2012
Internal Auditor
Prisma Health
01.2007 - 01.2008
Compliance Manager
Prisma Health
01.2006 - 01.2007
Provider Relations Ombudsman
Palmetto GBA
01.2004 - 01.2006
Master of Health Administration - undefined
Ohio University
Bachelor of Arts - Biology
Hampton University
Doctor of Health Administration -
Medical University of South Carolina
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