Own the cost and quality of all care provided by hospitals and specialists outside of our PCP teams. Executive Team member overseeing 30 clinics in 7 markets.● Opened two new markets during the COVID pandemic. Hired and trained Market Directors while curating networks of high quality, low-cost providers to care for our patients. Supervise Referrals staff, Case Managers, Transitional Care Coordinators, Social Workers, and employed Specialists.● Primary liaison between national payers and local markets. Coordinate JOCs, educate internal stakeholders to the nuances of full-risk Medicare Advantage capitation models, and ensure that payer interfaces share accurate data payments.● Director of the best performing market in the enterprise, managing KPIs better than markets that have been established for 30+ years.● Business principal for tiger team that focused on the number one medical cost driver, Cardiology. Estimated annual savings of $7.2 million.

Helping all types of healthcare providers position themselves for Value Based Contracting and Population Health Management. Advising in pro forma development, contract design, revenue cycle and financial operations, data analysis, and reporting.

Responsible for all aspects of revenue cycle management and payer relations: commercial, governmental, and grants.Lead a team of 17 in contracting, credentialing, billing, collecting, posting, and appeals.● Completely redesigned the Managed Care department, installing new tools and workflows to optimize performance.● Created a new Professional Corporation to work alongside the established facilities, allowing the opportunity to bill for services previously unbillable and streamlining operations while affording the opportunity to enter lines of business beyond traditional S.U.D. treatment. Created every aspect of the new provider group, from corporate structure to human resources.● Established first professional credentialing program, with policies, procedures, and KPIs for a group of over 100 providers.● Negotiated and operationalized one of the first population health / behavioral health relationships in the state of Illinois.● Renegotiated nearly all fee-for-service contracts within 9 months of hire, securing strategic and operational victories while also ensuring year-over-year increases.

As the first person to have this role - led all contract negotiations and operations with payers towards full risk HMO agreements. Managed all aspects of both the preferred and delegated networks.● Executed full risk agreements with every critical payer in Medicare Advantage, Dual Eligible, and Medicaid populations; often the first such relationship for the payer in the market.● Built the team that managed the day-to-day operations with a portfolio of a dozen payers, generating ad hoc solutions to operational problems and creating policies, procedures, and workflows to prevent theirreoccurrence.● Designed and negotiated a delegated referral network of specialists and facilities that both satisfied the largest payer in the state of Illinois while also meeting the needs of eleven clinics across all of Cook county.● Chaired the Managed Care Strategy group of C-Suite executives and Corporate Development leaders, which dictated the direction and focus of this hyper-growth organization.● Created and led the Policy and Procedure committee.

Advised senior leadership on trends, threats, and opportunities in the dynamic health care financial landscape. Educated physicians, staff, and patients of the same. Thought leader facilitating the transition from fee-for-service to population health management. Member of executive group that developed and refined the 5-year strategic plan for growth and sustainability of the organization.● Achieved first full risk, Medicare Advantage agreement in the history of the organization. Led everycomponent, from modeling rates to negotiating terms to marketing and implementation afterward.● Optimized termination threats/notices from 4 of the top 5 payers in the market. Leveraged the reopening of those agreements to add the affiliated physicians of a burgeoning clinically integrated network while minimizing the financial impact on the system. Secured payers into multi-year agreements with guaranteed annual increases, stabilizing revenue streams during a period when many other providers were forced to take reductions.● Developed the first Oncology Medical Home relationship with payers. Partnered with oncologists to develop appropriate diagnoses to target and quality measures and outcomes to track. Evaluated OMH’s performance and expanded to more diagnoses and payers.● Led the research, planning, and implementation of the Medicaid managed care strategy. Negotiated contracts, oversaw implementation of custom relationships, and troubleshot operations for the largest provider of Medicaid services in the state of Illinois.● Supervised department of 10 contractors, analysts and administrative staff - earning top employee satisfaction ratings across the system.

Managed all aspects of the contractual relationships between regional and national insurance carriers and Advocate’s Hospitals, employed physicians, and the independent physicians of Advocate Physician Partners. Negotiated capitated, fee-for-service, clinically integrated, and accountable care agreements representing $2B in annual revenue. Ensured that the payers are conforming to and educating internal stakeholders on the terms of the agreements.● Negotiated a new hospital contract with the second-largest payer in the market, achieving a 5% increase in the Medicare Advantage reimbursement and automatic, annual increases for the commercial network. Previously, the reimbursement had remained stagnant for eight years.● Identified a claims payment error that affected over 100,000 physician claims. Redressed the underpayments without incurring the operational expense of correcting each claim.

Directed all provider relations and contracting for the states of Illinois, Wisconsin, and Indiana; a territory including over 400 hospitals and 50,000 providers. Managed all aspects of the regional office, exceeding personnel and productivity goals while staying under-budget. Collaborated with Sales and Executives to create and implement strategic plans and develop products.● Renegotiated agreement with a large health care system of over a dozen facilities and 600 physicians, developing a tiered reimbursement system that effectively doubled the discount at the largest provider in the state.● Designed an Exclusive Provider Network by analyzing the entire Midwest marketplace using financial, geographic, and market data to target both the highest volume network providers and key providers for high profile clients.● Investigated the agreement with an academic medical center and identified a single provision in place for years that had been significantly reducing the effectiveness of the reimbursement structure. Negotiated new terms that exceeded an additional $1 million in annual client savings.

Advised health system executives in maximizing net revenues from managed care contracts. Implemented claims management and decision support systems for commercial payer and Medicare contracts. Led cross-functional teams of 2 to 6 people. Developed strategic plans and market benchmarks for executives to utilize in negotiations with major payers.

Primary liaison with over 5,500 health care providers. Responsible for strategic planning, marketing, new business development and all aspects of provider interaction from recruiting and leading contract negotiations through all communications regarding existing relationships. Performed market share rightness-of-fit and disruption analyses.