Joe Ware Email & Phone Number

Jupiter, Fl, Us

Jupiter, Fl, Us

Arlington, Va, Us

• Subject matter expert (SME) on healthcare pricing and reimbursement• Played a key role in the development of 2 brand new provider owned health plans in under 6 months• Contracted for multiple products including Commercial, Medicare, and EPO’s • Responsible for the creation of all provider pricing reimbursement for all provider types for all health plan clients.• Oversee all pricing updates including quarterly and annual Medicare updates• Provide strategic and analytical support for our health plan clients• Play a key role in educating health system executives on how to be health plan executives• Successfully achieved competitive provider pricing for new health plans• Balance demanding travel with a heavy work load• Frequent interaction with our client executives• Work independently in a matrix organization• Support our Value Based contracting team• Acting as managed care department for client by leading negotiations and bringing many traditional fee for service agreement to successful closure• Manage a team of 5 high performing direct reports• Act as liaison with our TPA to ensure proper pricing configuration• Proactively educate health plan client contracting team on TPA approved methodologies• Successfully took the contracting lead with several high priority/high cost health system on behalf of our health plan clients• Oversee national vendor and ancillary contracting on behalf of Evolent and health system clients• Successfully contracted a very competitive wrap network arrangement• Actively involved in cost containment initiatives – identifying network opportunities and claims overpayments• Creating alternative payment methodologies – bundled payments, risk arrangement, etc.• Developing creative provider incentive programs to achieve competitive narrow network market place pricing while incentivizing quality outcomes

Pittsburgh, Pennsylvania, Us

• Responsible for negotiating all managed care contracts for a 5 hospital, 700+ provider health system• Point person for negotiating and implementing several high performance networks• Created a user friendly internal SharePoint site to communicate managed care information to all employees• Obtained delegated credentialing agreements with all major carriers• Supervised a 13 member staff responsible for negotiating contracts, contract analytics, and provider enrollment and credentialing• Assisted revenue cycle with identification and resolution of claims issues • Actively involved in several committees including; care management, primary care quality improvement, and appeals/denials management• Played in integral role in converting Suburban General Hospital into a physician based practice

• Responsible for all provider contracting in a 16 county service area with emphasis on hospital contracting• Successfully expanded our Medicare product by 7 counties in a 3 month time span

Pittsburgh, Pennsylvania, Us

• Developed very strong, positive hospital relationships in the western Pennsylvania area• Negotiated and administered all hospital contracts• Successfully doubled our hospital network• Developed market competitive hospital outpatient fee schedules• Responsible for negotiating reimbursement rates with large physician and ancillary practices• Managed a staff of seven provider contractors• Responsible for implementation of testing requirements for Sarbanes-Oxley• Led a recovery audit team; identified and recovered $1.4 million in claim overpayments in a 6 week period

• Supervised the development of utilization management software, effectively matched referrals and prior- authorizations with claims• Created specialized reports from Access and Excel, including a medical expense profile report that calculated the per member per month cost for our primary care physicians• Created and monitored our preventative and outreach care programs• Updated information on our website and educated physician’s office personnel of its functions• Managed all aspects of network reimbursement

• Negotiated contracts with traditional and managed care insurance companies• Managed accounts receivable and reconciled insurance payments to contract terms• Maintained all liability files, including malpractice claims• Updated credentialing files for all practitioners• Educated staff on specific insurance payer issues and procedures

• Successfully transitioned electronic claims transmissions to Madras, India office via video Tele-conference and email• Set up 25 facilities simultaneously in ten states; included electronic transmission agreements and provider enrollment issues for over 100 physicians• System administrator for our billing (Medic) computer system• Managed accounts payable and assisted in company payroll

Mba, Health Systems Leadership

Bachelor Of Science - Bs, Health Policy And Administration