Eric Hales Mha, Chie Email & Phone Number

Overseeing all provider contracting and provider relations activities for the state of Utah. Manages a portfolio of more than $4 Billion in annual claims costs.

Hartford, Connecticut, Us

Chillicothe, Ohio, Us

 Successfully created and executed a new TPA to manage health benefits and strategic initiatives resulting in reducing Adena’s health benefits spend by 38% Oversee Sales & Marketing, Provider Contracting and Network Development, Pharmacy Benefits, Finance, Legal, Claims and Customer Service Advise clients for optimal plan design Assist the Medical Director establish protocols for managing the health of targeted populations including full utility of Patient Centered Medical Home and Inpatient Navigation Full budget, profit and loss responsibility for start up and ongoing operations Develop and execute strategic plan to enter health plan market and assume health insuring risk  President of Adena Care Board of Directors

Chillicothe, Ohio, Us

 Lead negotiations with payers of commercial insurance, managed Medicaid and Medicare Advantage resulting in $19 million improvement to net revenues Identified and successfully concluded payer claims settlements resulting in $3.2 million recovery Assisted enterprise-wide budgeting process by modeling and preparing projected contractual discounts with contracted payers Financial Liaison to implement Telemedicine system-wide and with non-Adena owned entities Key member of strategic initiatives to establish an Accountable Care Organization, Patient Centered Medical Home, a Management Services Organization, and Delegated Credentialing  Trained in LEAN/Six Sigma

Leader in the individual health insurance market with operations in 13 states with over $300 million in annual premium and nearly 180,000 membersDIRECTOR, PROVIDER NETWORK AND PROVIDER RELATIONS,Reports to the President and Chief Executive Officer of the companyEstablish a proprietary provider network in key states starting with Ohio and Indiana consisting of Hospitals, Physicians and Ancillary providersCreate new processes for the company to reprice claims and electronically capture provider demographic informationCreate contracting strategy including reimbursement terms, contract language, identifying key providers and hospitalsOversee the migration of membership to the proprietary provider network

Saint Louis, Mo, Us

Centene is a leading Payor of Government Sponsored programs with over $2 Billion in annual revenues. Multi-line, for profit, Care Management Organization with operations in 7 states with nearly 1.3 million members. Lead negotiator in multiple Hospital, Physician Group, IPA/PHO, Ancillary and Specialty Providers Key contributor in creating start up operations with a state-wide provider network consisting of 12,000+ contracts Liaison between the Plan and the State Department of Community Health to report on network development and other key metrics measuring Plan compliance and performance  Strategize contracting with key physician groups to participate with corporate specific capitation and bonus incentive program Oversee a team of negotiators to achieve contracting and network development goals

Murray , Ut, Us

Reports directly to the Vice President of Provider Relations.Negotiate contracts resulting in $8 million annual reduction to medical expensesOversees the development and maintenance of the physician's fee schedule Lead development of new PPO Network including hospital, ancillary, and physician groupsDevelop a strategy to monitor contracted vendors' service quality performance resulting in improved member satisfaction scoresChair the Contracts and Reimbursement Committee of the Executive Team and numerous other committees to create strategies, action plans and implement quality control processes Create strategic plans to improve department's participation in Regional Network Management Committees by creating specialized reports central to key decisionsEric P. Hales page 2

Rated the Number One Health Care Delivery System in 2002-2005. Multi-Hospital, integrated delivery system including a Health Plan with 500 thousand members.

Negotiated contracts with multiple provider types resulting in $3 million reduction to medical expensesDeveloped a process and recommended to senior system management the number of physicians to add to the network of providers.Chaired annual NCQA Member Access Review Committee to develop plans to improve member's access to providers that satisfied accreditation requirements.Created a physician office wait time survey which monitors the amount of days to wait for a new patient, routine visit.

South Bend, In, Us

Nationally recognized diversified health system serving a multi- county area employing over 3000; 500+ bed regional tertiary care hospital generating $240 million annual revenues. Recognized as Top 100 Hospital in Orthopedic and Cardiovascular services.

Managed $3 million budget at two physician sites. Improved variance in net contribution through cost reduction strategies including creative staffing to decrease overtime.Improved Medicare compliance and claims filing accuracy by educating staff and creating reference aids.Created teamwork to manage staffing and operations issues.Improve collections of accounts receivable from 107 to 56 days while decreasing expenses.Implemented decentralized patient flow system within multiple-physician group that included building modifications, workflow, job duties, and process redesign resulting in decreased staffing and optimal growth potentialMaximized work processes and quality patient care and satisfaction while maintaining staff loyalty and effectiveness

Redesign work process in Breast Care Center that included evaluating computer system to automate billing, film tracking, and production.Devised process for management of hospital's community benefit fund expenditures. Generated statistical and financial information for the Board of Trustees.Developed pro forma for development of Leighton Memorial HealthPlex.Lead contract negotiation for non-emergent transportation.Chaired National Hospital Week committee.

Ba, Psychology

Masters, Hospital & Health Administration