James Crones Email & Phone Number

Downers Grove, Illinois, US

Indianapolis, 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.

Louisville, Kentucky, US

Humana 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.

New 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.

New 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.

• 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.
• 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.

• 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.
• 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.
• 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.

Bachelor Of Arts, Business Management

Education record