Paragon Healthcare, Inc.

Responsible for managing day to day operations of the Managed Care department, payor contracting, contract administration, and execution of payor strategies across enterprise business units.

Senior Director, Payor Contracting & Managed Care

Responsible for managing day to day operations of the Managed Care department 
Execution of payor strategy and increased access to patient lives
Manage and negotiate a wide range of managed care contracts to support commercial contracting efforts; including payor contracting and credentialing for providers across various sites of care:
- 45 infusion centers
- 19 pharmacies 
- 100+ Nurse Practitioners 
- 20+ Supervising Physicians 
Liaison to RCM and Patient Access for cross functional support 
Contract re-negotiations 
Development and management of credentialing and contract administration workflow

Director, Managed Care

Soleo Health

Responsible for managing day to day operations of CenterSource™ (national centralized intake team) and support for branch intake
Scaled CenterSource™ team virtually from 2 to 45+ employees; including new referral benefit verification, clearance, re-authorization, and re-verification teams
Developed standardized specialty/acute intake workflow strategy, implementation, execution, and ongoing technology improvements/optimization
Developed and implemented standardized front-end processes, training materials, and work instructions leading to lower accounts receivable (A/R) risk, industry low days sales outstanding (DSO), and increased billable copay assistance ($MM)
Established and reinforced national intake service levels, therapy based key performance indicators, and executive reporting requirements
Full cycle recruitment including sourcing, interviewing, hiring, training, development, and managing team of 45+ direct reports and 35+ dotted line reports
Extensive knowledge of U.S. healthcare reimbursement mechanisms (CMS, third-party payor coverage, clinical and procedural coding) and regulations related to drugs and ancillary services
Payor contract analysis and interpretation, such as reimbursement methodology (benchmarks and terms), fee schedules, exclusions, limitations, performance guarantees, and product gross profit
Developed and implemented (with clinical team) review process to prevent pre-claim payor denials and post-claim payment denials resulting in expedient plan approvals and payments ($MM)
Integral in operationalizing successful therapy launches (new drugs, LDDs, existing drugs), new payor implementations, and streamlined transition of M & A patients across the enterprise
Integral in creating client statement of work procedures and operationalizing successful data capture for drug manufacturer/payer reporting
Supported revenue cycle management (RCM), sales, and operations in private equity backed business with significant growth from 2015 -2022 ($MM)

Director, National Intake & CenterSource™

Option Care

Intake Manager

US Bioservices

Benefit Verification Team Lead & Trainer

Amerita, Inc

Intake Coordinator

CVS Specialty

Eckerd Drug Inc

Pharmacy Clerk

My “why” and passion is to educate others on how to successfully navigate and overcome therapy access barriers in an ever-evolving managed care landscape. With over 22 years’ experience in specialty pharmacy, home infusion pharmacy, and rare/orphan therapy patient access, I provide expertise and education on best practices of medical/pharmacy benefit verification, prior authorization processes, denial appeals, reimbursement maximization, bad debt reduction, managed care, decreased DSO, and expansion of high functioning teams through rapid growth. Is that your “why”? Let’s connect!

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Minnie Castañeda Becker

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Minnie Castañeda Becker

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