• Established successful consulting firm with two partners on a mission to affect REAL change in the healthcare industry, serving both payers and providers.• Support client engagements including Network Strategy, Network Expansion, VBC/IDN Value Prop, ACO & CIN Strategy, Market Growth Strategy/Implementation, MA Strategy/Application/Implementation, MSSP/ACO REACH implementation and Operations, Provider Performance Analyses, Payer Strategy & Contracting/Analytics Support.• Focus on provider network, revenue & expense, provider value, payer profitability analyses.

• Managed all corporate provider network development/engagement initiatives.• Lead team of 30 to 40 recruiters, staffed projects as needed nationally to accomplish goals.• Responsible for client relationships & retention.• New business development, proposals, staffing plans and SOW's, contract terms and compensation.• Overall division P&L responsibility.• Ongoing development of Glenridge technology solutions for network optimization and industry value-prop.• Served as Data Manager/Project Manager on specific high-visibility client engagements.

• Provided extensive health care consulting services and Project Management to a diverse clientele including managed care organizations, health care providers, disease management companies, research organizations and others at local, regional and national levels. • Engagements include contracting & negotiations, network development (provider recruiting), strategic & e-business planning, software development, web development, business operations management, pricing analysis & technology assessment.

• Deployed a fully functional, multi-location Provider Relations Department for Inova’s developing Health Maintenance Organization. • Developed staffing and budget plans, participated in identification and selection of information systems, responsible for supervising, training and motivating staff, developed department policies and procedures, provided periodic management reports and analyses of operational successes and deficiencies, provided on-going process improvement analysis, systems analysis, developed and managed end-user provider database system.• Division lead-technical analyst in the configuration and implementation of Amisys information system (provider sub-system); provided direct technical support, business needs analysis, system configuration, testing, and training of end users.• Daily management of all aspects of health plan Provider Service (call center environment) and Provider Relations units. Interview potential candidates and select best talent available. Provide ongoing training, coaching, counseling, performance plans and evaluation to all direct reports.• Established and implemented provider education program.• Development and maintenance of provider database; perform gap analyses, produce physician directories, develop management reports.• Responsible for physician network contracting, education, satisfaction, service and retention.

• Provided technical and managed care expertise to the Vice President, Provider Networks on key corporate initiative: “Primary Care Physician Recognition Program”.• Defined project scope, established timelines and incremental goals. Coordinated efforts with six divisions and ensured adherence to quality standards and timeliness.• Presented program and initiatives at physician focus groups. Solicited feedback, responded to queries and issues raised, revised business plan and project scope as appropriate.• Provided periodic communications and analyses regarding progress, established post implementation processes to ensure successful delivery to provider community.

• Recruited and serviced providers for all lines of business (Managed Care, Preferred Provider, Select Preferred Provider), maintained positive, professional relationship with providers and office staff.• Increased provider network by 75% in identified development areas.• Developed and implemented automated “provider contact data system” for management reporting within the Medical Affairs division, wrote policy considerations for its use and implementation within the Provider Services Department.• Selected as primary recruiter for Professional Relations Representative Section.• Conducted seminars and orientations for new and current providers and/or staff. Educated participants on policies and procedures regarding all lines of business. Promote positive company image.• Publicly addressed professional associations regarding business changes and trends.• Provide statistical analyses of project progress.

• Senior Case Manager investigating member complaints regarding claims and quality of service issues.• Coordinated and assigned all cases and ensured their timely resolution.• Maintained statistics to ensure that all cases were closed in accordance with industry standards.• Researched and responded to written and verbal provider inquiries regarding finance issues, claims and policy issues. Provided resolutions and alternatives.• Selected by Director to represent the Provider Relations Department on the “Account Management Team” for critical VIP Account.

• Reviewed encounter claims for eligibility and benefits utilizing current CPT and ICD-9 coding.• Tested processing reliability with new Primary Care reimbursement system, developed unique system enhancements to accommodate the new system and supervised its implementation.

13 Bravo (Field Artillery) and 13 Echo (Fire Direction)