Michael Kent Email & Phone Number

California, United States

Los Angeles, Ca, Us

Provide strategic direction and leadership through effective negotiation and implementation of various payment models and contracting strategy, cultivation of managed care partnerships and enhancing financial success of provider & hospital network. Ongoing development and expansion of new and existing payer relationships to address pressure on reimbursement levels. Management and creation of various contract language and negotiation strategies and continuous collaboration with payers on new payment models and other managed care business opportunities. Achieved average contract revenue increase over 8% through thirty successfully negotiated rate improvements and six disengagements.

Renton, Wa, Us

Responsible for significant negotiations with and developing partnership activities between Providence and various health plans, payors and accountable care collaboration ventures.Partner with executive leaders of Clinical Institutes to support and refine contracting approach to payers for specialized value-based bundled payment contracting initiatives.Completed comprehensive evaluation of contract performance with regional and national behavioral health payers and actively renegotiated terms at or above budgeted parameters to support Mental Health Institute growth initiatives.

Development of accountable health care delivery network by creating partnerships between health plan clients and provider organizations to ensure marketability and fulfilment of CMS network adequacy requirements. Manage new market provider network expansion strategy of government-sponsored health care programs (Medicare and Medicaid) across existing and additional service areas with hospitals, primary care, academic and multi-specialty organizations.Successful recruitment of group practices and hospital systems through creation and negotiation of various payment contracting and reimbursement methodologies, resulting in comprehensive provider network. Utilize and leverage various criteria, including interpretation and application of network adequacy standards, market intelligence and reporting to optimize provider network quality.

Us

Manage financial analysis, negotiation, renewal, implementation and documentation of rates, terms and language within agreements, including specialist, primary care, and surgery center providers. Lead relevant discussions with regional leadership including contracting strategy, network development and enhancement goals and optimal contracting operations. Develop, structure, review and negotiate proposals, analyses, contracts and contract amendments between downstream providers and HCPAMG to result in the provision of affordable care within contractual performance goals, including enhanced terms, proper system setup to promote payment accuracy, and correct implementation. Identify and resolve key issues to ensure overall compliance with financial, legal, regulatory, and business performance of current regional contracts in preparation for dual-eligible Medicare and Medicaid managed care demonstration program participation.

Denver, Co, Us

Responsible for the development, implementation, and management of all payor contracting activities related to managed centers in the western U.S. Created and designed clinically integrated ACO network for participation with major insurers. Advised clients on key elements of contractual performance, compliance and revenue improvement opportunities. Formulated and developed payor contracting strategy on commercial, Medicare Advantage, Medicaid Managed Care, state and federal sponsored business with various reimbursement sources to provide services for and meet needs of health plan members.

Us

Conduct contract negotiations with medical providers, including medical groups, IPAs, hospitals, and ancillary services. Duties include drafting and implementing contract language and rate parameters, communicating legal requirements and ERISA self-funded business requirements, and developing competitive rate structures to present to contracted parties for commercial lines of self-insured business for Great-West Healthcare, now part of CIGNA

Us

Developed and refined acute facility contracting infrastructure represented by over $300 million in institutional expenses covering forty individual and system-supported hospital contracts. Accomplishments included: • Acquisition and effective management of several hospital contractual relationships, and enhanced productivity and flexibility of current relationships, via business process redesign and contract management infrastructure development.• Formalized hospital contracting strategy for the company by assessment of contracting opportunity, partnership potential, business requirement and pricing considerations, in conjunction and collaboration with corporate senior management and regional leadership, to achieve and sustain business objectives and long-term viability. Developed business model to sustain both current and future referral patterns to provider entities,

Los Angeles, Ca, Us

Management of health plan and state government institutional contracts for CHLA, especially in the area of cardiothoracic and liver transplantation. Keynote author of CMAC proposal to State of California to retain and enhance Medi-Cal funding. Collaborated marketing and business development activities with key physician leadership in academic divisions of medical center, including Vaughn Starnes, MD and Rick Selby, MD.

Master Of Business Administration - Mba, Health/Health Care Administration/Management

Ba, Psychology