Extensive experience building provider networks for Commercial Health, Workers Compensation, Auto Medical and VA.

Ambitious results-oriented network development professional responsible for execution and achievement of regional goals, objectives and results. Including day-to-day operation that focuses on decisions at major project or functional project level within assigned region. Extensive experience building competitive PPO, Workers' Compensation and Auto Medical networks.•Execute regional PPO, Workers' Compensation and Auto Medical network contracting objectives set by Sr. Management.•Exceeded network goals set by Sr. Management for 8 straight years which resulted in increased revenue for the company and team achieving highest bonus possible.•Project Manager for client specific network build including pre-award and post award activities for the VA Community Care Network.•Ensure establishment and maintenance of superior relationships with providers in assigned markets.•Facilitate training opportunities for contract team members including full understanding of company products, and command of negotiations related to contractor's position.•Oversee entire negotiation and contract development processes for assigned staff. Process included reviewing and approving contract language, reimbursement and contract preparation.•Lead complex provider negotiations with key market providers.•Experience with multiple reimbursement methodologies including, MS-DRG, Per Diem, Per Case, RBRVS and percent of Medicare contracting.•Partner with Healthcare Economics Department to conduct financial analyses and monitoring of market trends to identify, develop, and implement competitive reimbursement for assigned Region.•Participate in active dialogue with sales and account management to assess network adequacy and to anticipate client expectations.•Select, develop, evaluate, mentor and manage staff to ensure regional network growth and development of a productive team.

•Negotiate and execute provider contracts (Health System, Hospital, IPA and PHO agreements) to support network adequacy and reimbursement objectives relative to competitive market trends, client expectations and regional specific contracting goals.•Foster and maintain superior provider relationships. •Conduct in-person meetings and presentations with key providers in assigned markets.•Respond to provider questions, issues, and problems when escalated by service department.•Consistently exceeded contracting production goals and quality standards every year as set by Sr. Management, which resulted in increased revenue for the company.•Experience with multiple reimbursement methodologies including, MS-DRG, Per Diem, Per Case, RBRVS and percent of Medicare contracting.•Comply with mandatory training programs requirements, including product orientation, contracting tools and company resources.•Ensure compliance with established policies and procedures including regulatory requirements such as, HIPPA and NCQA.•Mentor junior contractors and assist when needed.

•Negotiate and execute provider contracts (IPA, Ancillary and group agreements) to support network adequacy and reimbursement objectives.•Respond to provider questions, issues, and problems when escalated by provider service department.•Foster and maintain superior provider relations in assigned markets.•Exceeded contracting production and quality standards consistent with established regional goals on a consistent basis.•Ensure compliance with established policies and procedures.•Involved in client specific network builds that result in additional revenue for the company.