Robbin Smith Email & Phone Number

Sullivan, Mo, Us

Minnetonka, Mn, Us

Saint Louis, Mo, Us

Provide leadership and process structure to health plan / affiliate vendor contract builds.•Built health plan / affiliate vendor contracting reporting platforms to support regulatory compliance and financial risk reduction. Additional support included:•Lead conversion of affiliate vendor agreements to new license business entity platform across multiple Centene health plans.•Managed 200-250 annual transactions with an average docket of 250 pending transactions.•Assist health plan customers in formulation of responses to state regulator objections to health plan affiliate vendor regulatory filings.•Lead affiliate vendor contracting in new markets including efficient hand-off to new compliance and vendor management teams.Lead projects to close compliance gaps in national agreements.•Lead project to identify compliance gaps in subcontractor agreement language across Medicaid products•Lead projects to close national agreement compliance gaps in ACA Marketplace products in multiple marketsLead projects to evaluate national contracting opportunities.•Assessed potential for national agreement with national ER professional group to close ACA Marketplace product network adequacy gaps for up to 10% of emergency room professional claims volume.•Developed dialysis “state-of-play” for deep dive into dialysis contracting•Assessed potential for national agreements in dialysis, parental infusion, airway clearance, incontinence product and augmentative communication spaces including evaluation of preferred contract rates as well as benefit coverage, regulatory and operational issuesLead contracting and implementation of 3rd party wrap network vendor solution for ACA Exchange out-of-network claims cost reduction with projected savings of $4.4 million.Lead integration of national provider agreements to acquired payor business for projected savings of $1.6 million.Lead national contracting workgroup supporting over 20 successful new market/product implementations.

Saint Louis, Mo, Us

Built operations infrastructure and audit capabilities to improve end-to-end administration of National fee-for-service agreements across 19 Centene health plan platforms.• Audited and corrected inherited 15 agreements across Centene health plan platforms• Improved contract administrative build accuracy and turnaround time through negotiated service line agreements with Centene health plans and corporate administrative functions• Built claims project process to resolve identified claims payment inaccuracies and increase provider satisfaction.Completed National contracting and administrative build for 15 new markets/products.Lead emergent transition for two health plans to using National durable medical equipment agreements after bankruptcy of capitated vendor.Built National Contracting portion of Centene response to multiple new business RFPsInterim non-emergent transportation contracting support to two health plan contract negotiations until permanent corporate consulting strategy and team was built.Provided key support for 2015 radiology benefit management vendor recontracting and administrative build for savings of $3.5 million.

Saint Louis, Mo, Us

Focused on identified network gaps remaining after early 2013 health plan launch.• Met management goal of implementing fixed/capped hospital ER rates on 15% of deficient contracts.• Met management goal of implementing charge master protection on 20% of deficient contracts.• Moved 3 of 4 assigned network gap non-par hospitals to active negotiation status prior to moving to corporate position.Added ACA Exchange product to targeted key hospitals in preparation for product launch.

Columbia, Mo, Us

Spearheaded client development for start-up product line providing medical records abstraction services to acute care hospitals. Target audience: Director-level and C-suite in hospital quality departments. Sales cycle: three months to one year. Annual per client revenue range: $40,000 to $200,000.Marketing: Promoted product line brand through multiple marketing channels including redesigned website, content marketing, e-mail marketing, conference exhibiting and direct mail campaign. Improved website stickiness as measured by visit duration, bounce rate and page views with resultant doubling of prospect inquiries. Grew permission-based e-mail marketing list from zero to over 1,500 health quality professionals.Sales: Increased monthly revenue from $65,000 to $130,000.

Developed and maintained ancillary, medical group, IPA, PHO and hospital agreements for multi-product health insurance organization in a 90-county service area covering Eastern Missouri and Southern Illinois.Developed cost-effective new contractual relationships as well as negotiated rate concessions in new or previously underdeveloped service areas to facilitate competitive product pricing.Re-negotiated and integrated assigned contracts from Coventry-acquired networks under Coventry Health Care of Missouri, Inc. provider agreements, often at more advantaged rates.Medicare Advantage: Developed provider networks for annual service area expansions and successfully negotiated and implemented new medical transportation vendor relationship with increased member benefit and lower plan cost.Managed mental health vendor contract and operational relationship covering 200,000+ lives including integrating multiple new groups each with greater than 25,000 lives.Provided functional expertise in large group implementation, plan operations, provider contract implementation and ad hoc project work groups as well as with mental health vendor delegation oversight committee.Provided functional expertise in delegated vendor audits including provider contract review for compliance with plan, state Department of Insurance, CMS and accrediting organization rules.Managed provider relations activities for 50 Tier 2 and 3 hospital facilities during 18-month interim assignment.

Irvine, Ca, Us

Developed and maintained a preferred provider organization for designated territory with $45 million of provider billings and $1.6 million in company revenue primarily in the workers compensation sector.Developed over 250 new contracts and renegotiated 150 contracts to move PPO discounts from an average 13% to 18% and customer PPO penetration from 69% to 82% for provider network including primary care, specialty, ancillary and hospital providers.Provided PPO network expertise during the sales and account management process including participating in select sales and account management calls.

Performed financial and market analysis as part of larger strategic planning and business development engagements, primarily for hospital and physician group practice clients.Presented results to the consulting team in the home office and to clients on-site.

New York, Ny, Us

Sell a variety of financial products including life insurance, annuities, mutual funds, disability income and long-term care insurance.

Developed and implemented goals/action plans for provider network development and provider relations in five-county St. Louis metropolitan area including rate and contract development. This included contracting 100 physicians and several hospitals in a 12-month period, re-configuring provider policy and procedures, developing a provider relations department, and developing schedules and methods of continued communication with the provider network including provider newsletters, fax communiques, and provider hotline. Supervised staff of 3 provider relations representatives and 1 community relations representative.Developed and implemented membership attraction and retention goals/action plans for 21,000 member Medicaid HMO. This included working with outside marketing firms and the Board of Directors to develop new plan identity and marketing strategy including new corporate identity, printed and broadcast advertising plan, and community activities and outreach.

Network development for 60+ county area.Completed HMO network development and state certification for several northeast and central Missouri counties.Negotiated cost-efficient contracts with volume hospital providers as well as primary care capitation and multispecialty group risk contracts.

Bachelor Of Arts, History And English Literature

Masters Degree, Health Administration