Barry Lionel Posner is a seasoned healthcare professional with unique cross-industry experience yielding demonstrated success in operational and strategic alignments between those involved in the delivery of healthcare services. Barry’s 30+ years of experience includes managed care contract negotiation, medical cost analysis, provider reimbursement & incentive strategies, and managed care laws & regulations. Barry is author of “Take Control of Your Healthcare Costs,” a consumer’s guide to affordable healthcare.Mission - To deliver high-quality healthcare advisory and consulting services at affordable costs, with a focus on thorough and data-driven analyses.Areas of Expertise - Hospital & Physician Billing / Medical Claim Analyses | Medical Cost Trend Analyses | Alignment of Service Delivery and Insurance | Managed Care Operations | Accountable Care Organizations | Medicare, Medicaid, and ACA Program Management | Healthcare Provider Reimbursement & Incentive StrategiesServices Offered - Managed Care contract negotiations, expert witness testimony (document review, report preparation, conducting research, sworn depositions, and trial testimony), healthcare investment advising, policy and article writing, and patient advocacy.Demonstrated Success - Forms Defensible Opinions | Writes Superior Reports | Exceeds Expectations | Dependable | Responsive | Available

Senior Manager, March 2014 – Present - BLUE SHIELD OF CALIFORNIA, Los Angeles, CA (2003 – Present)Responsible for all aspects of provider contracting, network development and cost containment for various geographic populations (Commercial, Medicare, Medicaid, ACA, Government programs).• Develops and maintains ACO relationships, including negotiation of target measures, performance metrics, and assisting in medical pathway improvements.• Acts as a subject matter expert on various Blue Shield committees, such as Best-In-Class Contracting Team, Reducing Cost of HealthCare, Invoice Elimination Project, and DMHC Disengagement Redesign.Network Manager, February 2007 – March 2014• Negotiated medical group, hospital and ancillary contracts to achieve under budget rate increases, multi-year agreements, model contract language, and defined incentives for appropriate medical management and steerage.• Developed and implemented regional cost savings measures and strategies by working with the provider groups and Blue Shield medical directors in analyzing financial and utilization data.• Assisted in the development and implementation of analytical tools used for financial measurements. • Participated on a committee to develop and implement a Competency Model for Contract Managers.Contracts Manager, February 2003 – February 2007• Negotiated medical group and hospital service agreements for defined geographic areas.• Managed provider relations meetings designed to collaborate on process improvements and compliance adherence.

Responsible for setting, monitoring and analyzing medical cost unit and utilization trends.• Managed and controlled the process of medical cost forecasting, trend analysis and cost reduction efforts.• Developed and initiated medical action plan for urgent care services steerage opportunities designed to save approximately 3% in outpatient costs over the next five years in the Los Angeles market.• Conducted hospital contract financial and stop-loss analysis, and claims audits to evaluate contract performance.

Responsible for all aspects of health plan, physician, and ancillary contracting for 20 medical groups.• Led contracting strategy meetings and developed a contracting manual to achieved regulatory compliance.• Achieved annual gross revenue increase of $1.2M through successful health plan rate re-negotiations.• Achieved $1.4M in provider incentive payments by ensuring regulatory compliance of key mandated HMO measures (i.e., encounter data submissions, timely claims payment, and provider solvency).• Secured a new health plan service agreement, resulting in increased earnings for four medical groups.• Achieved annual savings of $500,000 through successful re-negotiations of laboratory agreements.

Responsible for all aspects of network development, contract negotiations, and provider relations.• Expanded provider access in Inland Empire through focused network development, while maintaining market competitive rates and improving quality service.• Improved provider relations through problem-solving and resolution of challenging issues such as claims payment, eligibility discrepancies, and payment exclusions.• Eliminated membership loss potential by rapidly negotiating transfer agreements between KPC Medical Group and bankrupt Med-Partner at zero cost and no degradation in member satisfaction.• Developed centers of excellence for various specialties resulting in over $1M in annual cost savings.

Responsible for contract negotiations and analysis for physicians and ancillary providers.• Developed and maintained market competitive ancillary provider network. Saved more than $750,000 in three months by renegotiating and consolidating four locum tenens company provider agreements.• Improved inter-departmental relations by acting as an information resource on market activities.• Reduced medical care expenses by more than $3.2 million over two years in Kaiser’s Bakersfield area by renegotiating provider contracts and expanding new provider networks.• Received Service Excellence Recognition Award for immediately responding to a regulatory audit corrective action plan. Developed and negotiated contract language as required for regulatory compliance.• Reduced laboratory and radiology costs by an estimated 4% in Kaiser’s Bakersfield area by developing, managing, and analyzing Requests for Proposals, and awarding and negotiating contracts.

Responsible for representation of medical association membership across all aspects of medicine and the community.• Strengthened relationships with federal, state, and local health regulatory agencies by acting as government liaison and monitoring current health legislation and reimbursement trends. Successful efforts included writing and presenting testimony before the Los Angeles County Board of Supervisors.• Facilitated medical association involvement in community organizations and activities as primary staff director for six association committees and task forces, including Bio-Ethics and Public Health.• Developed and implemented physician continuing education seminars. Duties included full planning, obtaining speakers, and procurement of funds from pharmaceutical companies and other sponsors.• Developed and implemented streamlined application process for physicians to attain regulatory certification requirements for laboratory procedures, resulting in fifty offices receiving full certification.