Albert Ramirez Email & Phone Number

Nashville, TN, US

Nashville, Tennessee, US

Nashville, Tennessee, US

Working effectively with America’s Region Joint Venture partners or on my own accord to negotiate payer contracts, monitor contract performance, and to build productive relationships with commercial, Medicare advantage, Medicaid Managed Care, Direct employers and other third-party payers on behalf of the Region hospitals, ASCs, physician groups and other.

Bloomfield, CT, US

• Negotiates provider network contracts with complex physician groups and health systems to achieve competitive discounts, fair market unit costs and network accessibility and to obtain preferred contract structure.
• Performs financial analysis of contracts to determine impact on network discounts and unit costs using proprietary analytical tools and data utilization reports.
• Developed and implemented market physician network fee-for-service compensation schedules to achieve targeted 5% cost savings and competitive discount targets.
• Directed successful value-based, limited physician network development and recruitment and obtained regulatory approval to operate in Austin, Houston and San Antonio markets.
• Managed the implementation, operations and network relationship for Cigna’s delivery system alliance joint-venture partnership in Austin, Texas.

Bloomfield, CT, US

• Executed the initial phase of value-based physician group contracting across all Texas markets within the contract office.
• Negotiated hospital and physician group contracts to achieve competitive rates and enhanced network accessibility.
• Analyzed the performance of new and renewal contracts and the impact on network discounts and unit costs.

Bloomfield, CT, US

• Contracted with ancillary service providers and physician groups within budget requirements and adhering to preferred contract terms and conditions.
• Performed financial analysis of negotiated contracts.

• Directed a ten (10) person staff with responsibility for physician and ancillary services provider contracts, provider relations, recruitment and customer service call center operations.
• Developed policies for managing physician and ancillary services provider contracts, recruitment and communications.

• Renegotiated physician fee-for-service compensation schedules resulting in over 6% annual savings across Texas markets.
• Contracting efforts secured the company’s regulatory approval to operate in the Houston market and CMS license to operate a Medicare+Choice HMO plan in the Houston market.

After Aetna U.S. Healthcare acquired NYLCare Health Plans of the Gulf Coast, my role was integrated into an equivalent role with Aetna U.S. Healthcare.

• Recruited physicians and hospitals to expand the company’s provider network throughout Texas and southwestern Louisiana.
• Negotiated multi-specialty physician risk-capitation contracts supporting the company’s service area development of the Austin, San Antonio and East Texas markets.

Master Of Business Administration - Mba

Bs, Advertising