James Crones Email and Phone Number
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A talented Managed Care executive with twenty years of experience in network development, sales and marketing along with expertise in managed care, management and strategic planning. An energetic, enthusiastic and innovative professional who cares about people, is results oriented, and has a true sense of team.Specialties: • High Level Negotiations • Rate Improvement • Improvement to the Bottom Line • Consultative Selling/Negotiating • Productivity/Efficiency Increase • Client Relationship Building/Management • Operations • Broker Relations • Supervision and Team Building • Self/Fully Funded Insurance Products
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Director Managed Care ContractingAdvocate Health Care Oct 2015 - PresentDowners Grove, Illinois, Us
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Vice President Of Contracting And Network DevelopmentManaged Health Services - Centene Corporation Aug 2014 - Oct 2015Indianapolis , In , Us•Establish the department’s strategic vision, objectives, and policies and procedures. •Develop, implement and maintain production and quality standards for the Contracting department. •Oversee network development staff and external consultants in the development of provider networks across expansion markets. •Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Company goals. •Manage budgeting and forecasting initiatives for product lines to networks costs and provider contracts. •Oversee analysis of claim trend data and/or market information to derive conclusions to support contract negotiations. •Conduct periodic review of provider contracting rates to ensure strategic focus is on target with overall Company strategy. •Support market expansion and M&A activities by leading provider contract analysis related to due diligence. •Assist health plan CEO and/or COO vendors in key provider relations and strategy. •Ensure provider compliance with ADA requirements, accessibility and accommodations •Educate providers on ADA requirements and maintain ADA compliance -
Director Of Network Management And Provider ContractingHumana Oct 2010 - Sep 2014Louisville, Kentucky, UsHumana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and approximately 7.3 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals. -
Senior Ppo Network Development ExecutiveMultiplan May 2007 - May 2010New York, Ny, Us• Successfully integrated over $1 Billion in billed charges in IL, IN, MI and IA. • Improved revenue to the bottom line in excess of $5,000,000 over an 18 month span. • Successfully negotiated several key settlement agreements saving over $15 Million in corporate liability.• Recruit key hospitals and physician groups in IL, IN, MI and IA.• Develop and execute innovate negotiation strategies. • Develop/refine pricing models and strategies for negotiations to enhance revenue opportunities.• Develop and maintain positive relationships with hospitals and physician groups in IL, IN, MI and IA. • Coordinate approval processes of non-standard agreements.• Assist Brokers and Consultants in pre and post sale education sessions to existing and new clients. -
Executive Regional DirectorMultiplan Aug 2005 - May 2007New York, Ny, Us• Responsible for hospital and large physician group contracting and recontracting efforts in the states of Illinois and Indiana. • Assisted in the development of negotiation strategies that supported the goals/directives of the organization to improve revenue and enhance rate structures.• Successfully doubled revenue and discount structure from the largest utilized provider system in Illinois.• Recontracted one of the largest provider systems in the state of Indiana after their recent termination which saved a top ten client within the entire organization.• Assisted in restoring accountability and credibility in the Illinois and Indiana markets with respect to the reputation of the organization.
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Senior Consultant/Independent BrokerSelf Employed Jan 2004 - Aug 2005• Successfully completed a project for the largest complimentary national PPO network which involved integrating provider agreements at over 150 hospitals in Illinois and Indiana. In addition to restructuring the agreements, deeper discounted and multiple tiered rate structures were required strategies. Implemented within the expected timeline and revenue targets.• Successfully completed an Illinois Department of Insurance project saving 13 hospitals and 78 physician group relationships protecting over $64 million in billed charges.• Brokered small group and large self funded employer groups.• Directed contracting on behalf of employer groups within the provider community.
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Vice President Of Sales And MarketingPreferred Plan, Inc. 1992 - 2004• Managed a team of 28 responsible for network development, sales and marketing, operational development, data, EDI and repricing management, payer contracting, new product development, reimbursement strategies, lease arrangements, claim data analysis, benefit design consultation, and dispute resolution.• Guided the company to become one of the top three PPOs in the Chicago market with respect to total membership during the last eight years.• Sold the concept of “Network Leasing” to some of the largest PPOs in the country. This enabled timely and easy entrance into the marketplace and, at the same time, almost doubled the number of members accessing the network.• A significant contributor in converting over 80% of our contracted payers to internet repricing from expensive and outdated download strategies.• Played a key role in doubling the company’s revenue during the last two years.• Established the first fee schedule in the history of the company to enhance the value and savings of the physician component.• Successfully recontracted 98% of the physician component accepting the new reimbursement that achieved almost 50% more in savings.• Played a major and continual role in averaging a 20% or more average savings for the entire network during the last eight years.• Actively participated in the operational and contractual development of the EPO.• Developed and implemented the first organizational policy manual which assisted in the overall efficiency of the organization.• Developed and contracted a “Behavioral Medicine Services” network to assist clientele in realizing more savings for their respective plan designs that were non-existent prior to the formation of the network.
James Crones Skills
James Crones Education Details
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National Louis UniversityBusiness Management -
Wyoming Technical Institute
Frequently Asked Questions about James Crones
What company does James Crones work for?
James Crones works for Advocate Health Care
What is James Crones's role at the current company?
James Crones's current role is Director of Managed Care Contracting at Advocate Health Care.
What is James Crones's email address?
James Crones's email address is ma****@****ast.net
What is James Crones's direct phone number?
James Crones's direct phone number is +170835*****
What schools did James Crones attend?
James Crones attended National Louis University, Wyoming Technical Institute.
What are some of James Crones's interests?
James Crones has interest in Cooking, Volunteering, Electronics, Investing, Mentoring And Golf, Music, Sports, Movies.
What skills is James Crones known for?
James Crones has skills like Employee Benefits, Claim, Data Analysis, Crm, Credentialing.
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