Cheryl Wilson-Marton

5649 Upton Avenue South, Minneapolis, MN 55410

H: 612-926-0011
cherylwilsonmarton@gmail.com

SUMMARY

Resourceful Provider Relations Manager with proven results in reducing administrative costs to providers as well as the
corporation. Success as a strategic member of corporate leadership teams. Strong business, operational, regulatory and
compliance background developed through increasing responsibilities within the healthcare industry. Able to develop
rapport and credibility with diverse groups ranging from small providers to governmental agencies. Solution and results
oriented with an eye on both the big picture and the details.

EXPERIENCE

MEDICA HEALTH PLANS, Minnetonka, MN 1993 – 2009

Provider Relations Manager (2007 – 2009)

• Provided corporate oversight of implementing in 2009 the 2007 Minnesota state law that calls for
standardized, electronic health care billing transactions via Minnesota’s E3 Initiative to streamline three major
components of the billing process: Eligibility, Claims and Payment Remittance Advices, to minimize financial
penalties and fines.

 This initiative was accomplished via the Administrative Uniformity Committee (AUC).
 Provided direction, implementation oversight and training of the Eligibility process for Medica
effective January 9, 2009 prior to the state mandated implementation date of January 15, 2009.
 Provided direction, implementation oversight and training of the Claims 837 I, P and NCPDP
process for Medica effective July 15, 2009. In addition represented Medica on the Minnesota
Council of Health Plans (MCHP) to obtain a contract on ROI for a Direct Data Entry (DDE)
vendor i.e. IGI USA to provide services at no charge to small providers in order for the providers
to comply with the state mandate to submit claims electronically.
 Developed, provided direction and communication process for the 835 PRA mandate effective
December 15, 2009.
 For all three components created FAQ’s for both internal and external audiences, drafted articles
for publication in Medica’s Connection bulletin, provider alerts and worked in consultation with
both legal and regulatory compliance teams. Served as a member of the Joint Steering
Committee Senior Leadership team to provide insight on the decision making process to ensure
the implementation process was communicated and achieved.

• Facilitated Continuous Quality Improvement (CQI) Teams to identify administrative and operational
process improvement objectives between the health plan and targeted provider networks including but not
limited to Commercial and Government market business segments as well as the Labor Care market business
segment, to minimize financial risk.

 Reduced days in AR for facilities and clinics via reviewing their internal processes and the
health plan processes.
 Reviewed credentialing practices to reduce out of network reimbursement
 Rebuilt contracting relationships between providers and the health plan
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• Monitored and managed the implementation of the National Provider Identification (NPI) and Unique
Minnesota Provider Identification (UMPI) numbers within Medica for contracted and non-contracted providers,
to maintain compliance.

 Provided direction and oversight to ensure Medica complied with the state mandate to
load and process provider claims utilizing only NPI and UMPI provider numbers.
 Created and developed internal P&P’s for internal operations department to load
information into the processing system.
 Created FAQ’s for both internal and external audiences to comply with Medica’s
processes.

Provider Services Manager (2001 – 2007)

• Managed Professional and Institutional claim research teams for Commercial, Government and Labor
Care market business segments to ensure claim issue resolution on behalf of the provider community.

 Lead a team of Provider and Payer Analysts including Coding Administrators to research
and resolve escalated provider issues
 Assisted in the creation and development of Medica’s claims tracking tool e-PIL to track
all incoming claim issues, measure TAT, issue resolution, claim reports and provider database
information.

• Redesigned Medica’s Provider College curriculum to better meet the needs of the provider community.
Introduced adult learning theory techniques to engage participation from the attendees.

 Implemented provider survey tools to conduct topic creation for future trainings
 Implemented e-learning capabilities
 Created certificate series for new and seasoned business office staff

• Introduced and implemented departmental learning maps for seasoned and new employees within my
areas of oversight (i.e. Provider Analysts, Payer Analysts, Coding Administrators, Technical Trainer and
Education Coordinator).

 Created training and learning series for staff on development within their job
accountabilities
 Utilized learning map for individual and team achievements in addition to performance
appraisals

Contract Negotiator (1998 – 2001)

• Successfully negotiated multimillion dollar contracts between the health plan and various hospital
facilities to meet budgeted target percentages.

 Experience negotiating contracts for Facilities i.e. Hospitals, SNF (Skilled Nursing Facilities),
AmSurg (Free-standing ambulatory surgery centers), Homecare, RAPLET (Radiology,
Anesthesiology, Pathology, Laboratory, ER and Transportation) providers.
 • Charged with researching industry standard requirements and common billing practices of Skilled
Nursing Facilities, Nursing Facilities and Gatekeeper Partners in order to redesign the health plans ancillary
contracts to be more in line with industry standards.
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 Rewrote Medica’s SNF, NF and Gatekeeper Partner contracts to be in-line with category
requirements based on services being rendered.

• Designated as a key resource to rebuild and maintain the health plans relationship with the RAPLET
(Radiology, Anesthesiology, Pathology, Laboratory, ER and Transportation) community, to ensure network
structure reflected the provider community.

 Rebuilt multiple provider relationships between the provider community and the health plan to
maintain presence within the provider community.

Clinic Experience (1993 – 1998)

• Assistant Clinic Manager for Parkside Family Physicians

 Monitored days in AR for Internal Medicine and General Surgeon Practice

 Managed front desk staff
 Managed month end and year end processes for the practice

• Manager of Commercial Division for Consolidated Business Offices

 Provided oversight of business office staff for claim submission, cash posting, refunds
and collections.
 Managed month end and year end processes for commercial division
 Created departmental policy and procedures, hired, trained and termed employment of
staff due to poor performance

EDUCATION

University of Minnesota
3 years completed toward BA degree with emphasis in Marketing and Management

Lakeland Medical Academy

AA degree Medical Administration

Extensive ongoing professional development in topics such as:

Managing for Excellence Budget Management

Performance Management Project Management
Coaching Team Building
Fraud and Abuse Regulatory Compliance