Negotiating contracts with facility healthcare providers, professional healthcare providers, or other business partners on behalf of the company. Reviewing and approving contracts for legal compliance and making any changes necessary to ensure compliance. Preparing contract proposals for approval by senior management or legal counsel. Reviewing and approving fee schedules for services rendered by outside vendors, contractors, or healthcare providers to ensure that the costs match the scope of work outlined in the contract. Negotiating comprehensive reimbursement structures that contain both fee-for-service-based components and value-based opportunities for all provider types throughout Louisiana. In-depth experience with value-based contracting containing an emphasis on delivering high-quality care that leads to positive patient outcomes. Negotiating terms that center reimbursement around performance measures and outcomes, such as improved patient satisfaction, reduced hospital readmissions, or better management of chronic conditions. Encourage the delivery of evidence-based, patient-centered care with shared saving opportunities containing upside-only and risk-based models. Review contracts to determine whether they meet legal requirements and identify any areas requiring clarification or additional detail to prevent confusion or contractual variance later in the agreement's timeline. Manages all aspects of the contract both pre and post-execution, including negotiation of rate structure, monitoring performance, handling disputes, and addressing issues that arise. Reviewing proposals and negotiation requests from all facility provider types and or professional groups to determine opportunities to improve provider partnerships and what comprehensive reimbursement structure may be the best fit for both the provider and plan. Annual review of state laws and regulator mandates to determine if existing contracts require verbiage or policy updates.

Evaluated and negotiated contracts in compliance with corporate contract guidelines and annual budgetary alignment for the largest geographical region within BlueCross BlueShield of Louisiana’s network territory.Extensive knowledge in building high performance networks, dual eligible networks, and Medicare Advantage provider networks. Responsible for network development and implementing payment methodology that centers on pay for performance motivation in addition to fee for service contracting.Analyzed historical claims data and worked extensively with reimbursement analysts to determine projected spend on all pay for performance business models.Established and maintained strong business relationships with both financial and clinical personnel to ensure pay for performance models maintained viability with both facilities and professional practitioners.Developed a statewide reference lab network to increase service availability while decreasing overall member cost share. Utilized cave data scoring to implement and negotiate high performance networks and reduce plan pricing. Worked extensively with revenue cycle leaders to bridge contractual periods and insure claims payment was delivered per contractual guidelines.

Supervised eligibility process and proper account placement at 10 facilities in the Ark-La-Tex region. Negotiated reimbursement rates with clients to insure that a strong profit margin was maintained.State certified for processing Louisiana Medicaid applications.Worked extensively with patient financial services and patient access to insure proper DRG coding, authorization requirements, and timely billing potocals were utilized.Worked extensively with local Medicaid and SSI facilities to qualify patients for both medical health assistance as well as client reimbursement possibilities.Met monthly quotas for both account certification as well as financial reimbursement per client needs.

Increased referral levels by over 50% in rural areas. Demonstrated the availability of an increased profit margin for our company within the region.Established new Lincare locations due to high patient volume and available profit margin.Managed and maintained over 500 referral accounts.Responsible for coordinating clinical lectures and equipment demonstrations to referral sources to aide in increased patient referrals. Attended extensive training courses in sales strategy, inhalant respiratory medication therapy, management techniques, and sleep therapy.