Chyanne Jones
Chicago
Summary
Results-driven healthcare leader with extensive experience in managing provider relations, ensuring compliance, and optimizing network performance. Proven track record in developing and maintaining strategic partnerships with healthcare providers, focusing on alignment with contractual and financial requirements.
Overview
11
11
years of professional experience
Work History
Sr. Engagement Advisor & Strategy Manager
Evolent Health
Chicago, IL
02.2025 - 01.2026
- Engaged provider organizations to align strategy and performance outcomes.
- Facilitated stakeholder sessions to document business requirements and success metrics.
- Built long-term client partnerships through clear communication and delivery of value-driven solutions.
Director, Network Operations
Clearlink Partners
Houston, TX
03.2024 - 07.2024
- Developed process optimization strategies to enhance network performance.
- Collaborated with stakeholders to ensure alignment with business objectives.
- Provided training and mentorship to improve network operations team capabilities.
Manager, Provider Relations - Hospital Systems
Molina Healthcare
Bolingbrook, IL
11.2022 - 03.2024
- Resolved complex contract issues while ensuring compliance with regulations.
- Developed new provider markets, collaborating with cross-functional teams.
- Led quality metrics and training initiatives for provider utilization management.
Manager, Provider Implementation
OneHome
Miramar, FL
03.2022 - 01.2023
- Stakeholder Collaboration: Collaborated with senior leadership to review accounts receivable across all lines of business, including Medicaid, Medicare, and workman’s comp. Ensured financial efficiency and adherence to established guidelines.
- Team Leadership and Mentorship: Managed, trained, and mentored all staff involved in the provider implementation process. Provided guidance to ensure team members were well-equipped to handle the intricacies of the implementation process.
- Stakeholder Communication: Managed stakeholder communication, vendor management timelines, and provided regular status reports. Facilitated effective communication channels to keep all relevant parties informed and aligned.
- Software Platform Testing: Main Liaison for testing and troubleshooting new software platforms and configurations for each market rollout. Ensured that the technology infrastructure was robust and met the organization’s market requirements.
- Collaboration with Marketing and Software Teams: Collaborated with marketing and software platform team members to define and develop network concepts. Worked cross-functionally to align marketing strategies with the technical capabilities of the software platforms.
- Training Manual and SOP Development: Created training manuals and Standard Operating Procedures (SOPs) for new market providers. Ensured that the implementation process was well-documented and adhered to standardized procedures.
- Power BI for Provider Network Review: Utilized Power BI to generate provider networks and review provider gaps. Applied data analytics to identify areas for improvement and optimize the provider network.
- Implementation Meetings: Led implementation meetings and developed/presented implementation calendars to clients, vendors, and shareholders. Ensured that all stakeholders were aware of the implementation timeline and milestones.
Manager, Provider Network
Evolent Health
Chicago, IL
09.2017 - 12.2021
- Compliance and Training: Identified key compliance issues and implemented comprehensive training documents to educate providers. Ensured that providers were well-informed about compliance standards and operational protocols.
- Contract Evaluation: Evaluated provider contracts, reviewed contract rates, language, and assisted in contract configuration. Played a crucial role in ensuring that contractual agreements were fair, transparent, and aligned with organizational goals.
- Issue Resolution: Resolved all escalated provider issues, and addressed concerns promptly to maintain a high level of provider satisfaction.
- Network Optimization: Identified network gaps and implemented effective strategies to reduce provider network gaps. Worked collaboratively with internal teams and client team to ensure a robust and comprehensive provider network.
- State and Joint Operating Committee Meetings: Attended State and Joint Operating Committee meetings, actively contributing insights and updates related to provider relations. Ensured alignment with state regulations and organizational objectives.
- Documentation and Manuals: Developed and maintained Provider Manual billing guidelines, Provider Services Policies, and provider training materials.
- Billing Policies and Procedures: Formulated billing policies and procedures related to in-network providers.
- Operational Policies and Procedures: Created and maintained operational policies and procedures supporting organizational improvements. Ensured policies were regularly reviewed, updated, and aligned with regulatory requirements.
- Provider Orientations: Attended initial and subsequent provider orientations, maintaining compliance Ensured that providers were onboarded effectively.
- Dispute Resolution: Troubleshooted provider disputes and provided resolutions regarding HFS complaints. Conducted claims analyses for escalated provider issues, contributing to timely and satisfactory resolutions.
Manager, Member Incentives
Evolent Health
Chicago, IL
01.2019 - 12.2020
- Supervision and Direction: Supervised, directed, monitored, reviewed, and coached all MIP staff members, managing between 10-15 individuals. Provided leadership to ensure the effective functioning of the Member Incentive Program.
- Strategic Configurations: Assisted with the design, development, management, and implementation of strategic network configurations and integration activities for member incentive Contributed to the expansion and optimization of the network.
- Client Relationship Management: Managed vendor-client relationships, ensuring strong communication and collaboration. Worked closely with clients to understand their needs and align incentive programs accordingly.
- Implementation Projects: Created and oversaw implementation projects related to new processes and systems. Ensured that implementation plans were well-structured and aligned with client and company objectives.
- SOP Development: Created and maintained Standard Operating Procedures (SOPs) for employees to achieve quality output and uniformity. Ensured that team members followed standardized procedures for program effectiveness.
- Collaboration with Stakeholders: Collaborated with key implementation stakeholders to ensure the successful rollout of new processes and systems. Worked cross-functionally to address challenges and facilitate smooth implementations.
Provider Relations Rep
Evolent Health
Chicago, IL
06.2016 - 09.2017
- Provider Orientations and Site Visits: Planned, organized, and conducted orientations and site visits for Managed Long-Term Services and Supports (MLTSS), Community Mental Health Centers (CMHC), and Department of Alcohol and Substance Abuse (DASA) providers.
- Relationship Building: Built and maintained professional relationships with providers to ensure ongoing satisfaction. Acted as a primary point of contact, addressing concerns promptly and effectively.
- Dispute Resolution: Researched and resolved disputes, billing discrepancies, and claims issues immediately. Demonstrated a proactive approach to dispute resolution to maintain positive provider relationships.
- Process Improvement: Identified opportunities for process improvements within the assigned market. Collaborated with associates and managers to implement changes that enhanced operational efficiency.
- Claims Analysis: Conducted in-depth claims analysis and provided an overview of claims issues. Actively participated in escalated claims issues, facilitating meetings, and coordinating research to ensure timely resolution.
- Provider Portal Utilization: Assisted providers in setting up and utilizing provider portals and networks. Provided training and support to ensure seamless utilization of CCHHS technology platforms.
- Site Visits and Compliance: Conducted provider office site visits.
- Claims and Contract Interpretation: Interpreted claims and provider contracts to set up provider records accurately with configuration team. Ensured timely and accurate processing of claims, including appeals, denials, and retroactive payments.
Quality Specialist
Optum Health Care
Hillside, IL
01.2015 - 06.2015
- Educational Sessions: Assisted in planning, coordinating, and facilitating educational sessions for staff and physicians. Ensured that team members were well-informed about issues identified during Quality Improvement (QI) and Healthcare Effectiveness Data and Information Set (HEDIS) projects.
- Compliance Assurance: Ensured compliance with all state and federal regulations, including the Health Insurance Portability and Accountability Act (HIPAA). Compiled Quality Improvement (QI) data and assisted in the analysis of projects such as HEDIS, Risk Adjustment Factor (RAF), Facility Site Review (FSR), and Preventative Quality Indicators (PQI).
- Provider Communication: Communicated Quality Improvement (QI) information to providers to correct deficiencies and monitored provider progress to meet goals. Fostered collaborative relationships with providers to drive continuous improvement in quality metrics.
- PQI Activity Report: Prepared and analyzed the Preventative Quality Indicators (PQI) activity report, providing insights into key quality indicators and areas for improvement. Played a crucial role in maintaining and enhancing overall healthcare quality.
- Committee Participation: Served as a member and attended Quality Improvement/Patient Relations (QI/PR) committee meetings. Contributed valuable insights and participated in discussions aimed at improving patient care and healthcare outcomes.
- Patient Issue Resolution: Acted as a primary contact for assigned health centers and physicians to help resolve member issues. Effectively communicated patient needs to other parts of the organization and collaborated cross-functionally to develop solutions.
- Chart Abstractions: Conducted chart abstractions as part of the HEDIS project to measure health plan performance on key quality preventative indicators. Ensured accuracy in data collection and analysis for quality improvement initiatives.
Education
Bachelor's Degree - Business Administration
Charter Oak State College
Hartford, CT05.2011
Skills
- Provider relations
- Claims analysis
- Contract management
Timeline
Sr. Engagement Advisor & Strategy Manager
Evolent Health
02.2025 - 01.2026
Director, Network Operations
Clearlink Partners
03.2024 - 07.2024
Manager, Provider Relations - Hospital Systems
Molina Healthcare
11.2022 - 03.2024
Manager, Provider Implementation
OneHome
03.2022 - 01.2023
Manager, Member Incentives
Evolent Health
01.2019 - 12.2020
Manager, Provider Network
Evolent Health
09.2017 - 12.2021
Provider Relations Rep
Evolent Health
06.2016 - 09.2017
Quality Specialist
Optum Health Care
01.2015 - 06.2015
Bachelor's Degree - Business Administration
Charter Oak State College