Mike Himes Email and Phone Number

• Returned to Network Management in an expanded senior role; key responsibilities included handling key provider accounts, mentoring and coaching junior contractors, and leading process improvement initiatives• Cultivated provider physician network for UnitedHealthcare Network Management • Yielded a geographically competitive, broad access, stable network that achieved objectives for unit cost performance and trend management• Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls• Established strong business relationships with hospital, physician, pharmacy, and ancillary providers • Ensured the network composition included an appropriate distribution of provider specialties• Provided analysis, explanations and interpretations to peers and providers within area of expertise• Obtained favorable fee arrangements from all providers recruited in a defined geographic territory• Communicated with network management and support staff daily to report and request status inquiries• Administered provider contracting and network maintenance initiatives for the Austin, TX market (including but not limited to the counties in and around the Austin, San Marcos and Waco metropolitan areas)

• Partner with UHN and the Health Plans to validate the accuracy of network profiles, and implement remediation plans for providers with submission/accuracy gaps• Coordinate with care providers and medical groups to maintain current rosters, demographics and network status in our systems• Perform comprehensive data and contract reconciliations across all platforms• Manage change requests and data corrections through to claim payment and directory depiction database • Maintain current loading protocols for all provider groups across all products and network strategies• Proactively identify updates that impact claims and initiating member reassignments as needed• Ensure new contract provisions are successfully executed across all platforms and processes

• Cultivated provider physician network for UnitedHealthcare Network Management • Yielded a geographically competitive, broad access, stable network that achieved objectives for unit cost performance and trend management• Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls• Established strong business relationships with hospital, physician, pharmacy, and ancillary providers • Ensured the network composition included an appropriate distribution of provider specialties• Provided analysis, explanations and interpretations to peers and providers within area of expertise• Obtained favorable fee arrangements from all providers recruited in a defined geographic territory• Communicated with network management and support staff daily to report and request status inquiries• Administered provider contracting and network maintenance initiatives for the Austin, TX market (including but not limited to the counties in and around the Austin, San Marcos and Waco metropolitan areas)

• Cultivated provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) for the TRICARE military health network• Yielded a geographically competitive, broad access, stable network that achieved objectives for unit cost performance and trend management• Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls• Established strong business relationships with hospital, physician, pharmacy, and ancillary providers • Ensured the network composition included an appropriate distribution of provider specialties• Provided analysis, explanations and interpretations to peers and providers within area of expertise• Obtained favorable fee arrangements from all providers recruited in a defined geographic territory• Communicated with network management and support staff daily to report and request status inquiries• Administered provider contracting and network maintenance initiatives for the Austin, TX market (August 2009 to April 2010), the Orlando, FL market (April 2010 to July 2010) and all markets in the State of Texas (June 2010 to August 2010)

Data Infrastructure Services LLC (DIS) was established to become the premier provider of structured cable systems. We proudly serve the residential, commercial and new construction markets. DIS specializes in complete low-voltage and fiber optic cabling solution services including conceptualization, engineering design, installation, repair and utilization of the finest products available to the marketplace. With our focus set entirely on data systems, DIS is able to provide complete “turnkey” solutions, select services as needed, or provide expertise and services at any phase of a project.DIS strives for client satisfaction. This is achieved through not only an understanding of the project, but by also understanding the underlying needs of the client. With this comprehensive perspective, we are able to exceed client expectations and develop loyal relationships.

• Facilitated escalation support for data transmission problems to customer's end users, technical contacts, and help desk personnel • Answered customer inquiries and resolved order issues as they arose to ensure customer satisfaction• Supported the processes required to bring new Mobile customers live with Tangoe’s Mobile Device Management• Collaborated with users to resolve handheld messaging, synchronization, provisioning, and accessibility problems• Diagnosed, identified, performed troubleshooting, and resolved problems via phone and email support• Logged inbound support requests, troubleshooting and resolution activity within Tangoe's Help Desk problem management software• Maintained and updated Tangoe's Support Knowledge Base• Advised BlackBerry users via the BlackBerry Management tool, and Domino or Exchange users via the appropriate messaging environment management tool

• Managed 12 subordinate employees and oversaw day to day activities throughout department• Monitored department metrics and individual performances and reported to the Executive Committee• Directed training and professional development sessions• Supervised marketing standard and specialized projects for various managed care products lines• Conferenced with industry peers and C-suite executives to facilitate negotiations• Retained duties associated with National Contracting Director position in addition to the aforementioned

• Conducted market research activities to provide information relating to sales potential and market conditions for an organization's products and services• Renegotiated existing rates for contract services and agreement language• Maintained national PPO networks and Specialized networks of acute care general hospitals, ancillaries, IPA/PHOs, provider groups, and individual medical providers• Established marketing strategy and provided recommendations to management• Prepared monthly reports showing marketing productivity, administrative issues, goals and objectives• Surveyed provider utilization statistics and trends relating to insured steerage (inpatient admissions, outpatient cases, etc.), revenue, and monetary savings for clients

• Developed, built, and maintained national PPO networks and Specialized networks of acute care general hospitals, ancillaries, IPA/PHOs, provider groups, and individual medical providers• Worked with marketing members / contracting team to develop continuum of care / network referral patterns• Negotiated reduced rates for contract services and agreement language• Created reimbursement schedules for hospital services based upon Per Diems Rates, ASC Grouper Codes, DRGs, percentage discounts, and carve-outs• Delegated responsibilities to Marketing Coordinators• Presented formal marketing plan for targeted regions including evaluation of previous projects• Directed special hospital marketing projects inclusive of Worker’s Injury/Illness networks for the employees of the State of Tennessee, and Medicare Supplemental and Medicare Select Medigap plans

• Researched/located healthcare providers, facilities, and physician groups using phone and/or internet• Utilized contracting methods within standard operating procedures to efficiently build network relationships• Coordinated mail outs and follow-up with frequent verbal and written communications• Negotiated reduced rates for contract services and agreement language• Created fee schedules for physician/health care services based upon specific Medicare localities and standard Relative Value Units• Participated in special marketing projects inclusive of the CHIP of Texas physician provider network

• Prospected for cold call potential clients for online web based advertising• Demonstrated value added services and served as a product knowledge consultant for potential buyers• Consistently attained personal sales goal of $1500/month

• Received technical calls for the Microsoft XBOX console with a 7 minute handle time and 30 second wrap • Provided explanation of policy, procedure, and billing • Utilized extensive knowledge of XBOX hardware and accessories to identify and resolve problems• Initiated repair and replacement orders using Microsoft OMS with multiple payment formats• Defused difficult, irate, and emotionally charged customer call scenarios• Assisted retailers with troubleshooting for the “XBOX Interactive” displays and custom store displays• Input information regarding individual calls into local database• Researched order status within database and with carriers to resolve lost/delayed shipment issues• Registered customer and retailer information into the Microsoft CSS database• Dispatched technical representatives from TMG Solutions Inc. via the Quantam Community online database• Utilized the Rapid Displays online order system to complete hardware replacement orders

• Utilized NewsStation Producer and PowerPoint to update various aspects of the Billboard• Developed new slides for the Community Master and Rye City meetings• Operated the soundboard and studio cameras• Directed studio operations including lighting adjustments, set-up, breakdown, cued guests, and remote shoots on mini DV cameras• Copied and timed shows to fit the allotted program schedule• Produced programming to be aired using Trinity and Globe Caster non-linear digital editing systems• Performed linear editing to produce program tapes and copies• Recorded and produced voiceovers for show introductions• Created unique graphics and text for image overlay