Robert P. Theis, Jr. Email & Phone Number

Chicago, Illinois, Us

Plans, directs, and implements managed care policies, goals, and objectives related to reimbursement, negotiation strategy, and national payer relationship management. This position negotiates a wide-variety of fee-for-service and value-based contracts worth over $900 Million across all of CommonSpirit Health’s geographies, focusing on the largest national health insurers and their numerous business lines (e.g. commercial, government, and service-line specific).

Robert P Theis Jr Healthcare Consulting Services offers expertise, resources, and guidance to help our clients succeed in the Healthcare Industry. We help physicians/clinicians, hospitals, and ancillary providers in for-profit, PE/VC funded, and not-for-profit sectors to hone and refine their services and processes to provide the highest “Value” to their current and potential markets. ( Value = ( Excellent Quality + Outstanding Outcomes + Highest Patient and Staff Experience) / Lowest Cost)). We provide detailed strategic planning and financial analysis for new market development as well as developing and refining service line strategic plans and governance, improving employed/community physician collaborations and relationships, bolstering financial and quality performance, integrating elements of the continuum of care, partnering and negotiating with payor and vendors.

Falls Church, Virginia, Us

As Vice President of Operations, I directed medical campus and trauma center operations in a 1000 bed Medical Center. I managed finance, technology, outcomes strategy and professional and technical staff in Nurosience, Spine, Orthopedics, Lab, Radiology, Rehab and Blood Donor Services. I was responsible for the System’s Neuroscience and Spine Institute which spanned 5 acute care hospitals and integrated with our ambulatory care sites. A few key contributions include:• Coordinated lab services delivering 2.25M results annually, radiology services performing 265K studies annually, and blood donor services collecting 80K units annually.• Provided engaged, supportive leadership to interdisciplinary teams with ongoing development and performance management programs increasing employee engagement by 60% and reducing attrition to less than 6%.• Established neuroscience system service line by acquiring and expanding neurology practices, recruiting 10 subspecialty neurosurgeons, and partnering with community based physician groups to initiate 20 neuroscience focused subspecialty programs.• Integrated critical quality and safety standards reducing CAUTI by 28%, CLABSI by 43%, falls by 20% and increasing hand hygiene by 25% and patient experience by 60%.• Conducted in-depth analysis of operational efficiencies and costs and partnered with physicians, nurses, clinical and administrative support staff to integrate Lean activities, renegotiate vendor contracts resulting in higher quality and lower costs by $15million per year.• Oversaw neurology, neurosurgery, ortho trauma, and orthopedic physician practice multispecialty operations valued at $50M by expanding to five new sites of care while reducing losses by $6M annually.• Designed and relocated HOPD Radiology Suite and IDTF MRI Center generating $60M in revenue.

Falls Church, Virginia, Us

In this role, I spearheaded payor reimbursement and contract strategy supporting $800M+ in managed care carrier contract revenue. A few of my key achievements include:• Identified opportunities with service-line performance and renegotiated contracts increasing revenue by $190M, physician reimbursement rates by 100%, and transplant reimbursement terms by 45% with expanded participation.• Advanced net revenue goals by negotiating $800M annually with nations largest healthcare payors and implemented analytical tools and processes to drive revenue across physician, hospital ancillary, and specialty services.

Us

A for-profit, Fortune 100, health insurance company that provides health benefit plans and services to small and large employer groups and the federal government in Maryland, DC, Virginia, Pennsylvania, and West Virginia.• Developed and executed the network strategy for acute care providers and other free standing institutions in Northern Virginia and the District of Columbia within the health plan’s medical cost per unit trend budget. • Devised the Health Plan’s Request for Information (RFI) tools and processes that are now utilized as the baseline for assessment/re-assessment of specialized, high cost services (e.g. the Plan’s Centers of Excellence programs). • Developed and implemented contract and reimbursement strategies and network designs for Plan’s cardiac surgery, joint replacement/revision surgery, solid organ and stem cell transplant services, including reimbursement analytical tools for accurate and expedited reimbursement assessment.

Us

For-profit, Fortune 500 company, international, multi-specialty provider system offering inpatient and outpatient rehabilitation, outpatient diagnostic centers (i.e. CT/MRI), outpatient surgery centers, and chiropractic services..• Established and executed the regional strategic business plan for payor contracting for eighty (80) centers and partner physician groups in DC, DE, MD, and VA that produced monthly revenue of over $10 Million. • Successfully consolidated over 140 individual/center contracts resulting in improved payor relationships, more efficient operations, and more effective contract management.• Evaluated, negotiated and implemented managed care, indemnity and workers compensation payor agreements.• Developed and implemented analytical tools for evaluation of payor contract margin/profitability. • Implemented contract compliance activities and recovered underpaid/non-paid claims.

Washington, Dc, Us

Not-for-profit, pediatric and adolescent integrated delivery system consisting of a 279 licensed acute/tertiary bed hospital, 30 employed primary care physicians, and 220 employed specialist physicians.• Guided the growth of key managed care business opportunities. • Structured, evaluated, analyzed and negotiated primary care, specialist, and hospital contracts with Indemnity, PPO, POS, HMO and Managed Medicaid HMO payors. • Exceeded FY ‘00 and ‘01 revenue targets by over 300%. Negotiated rate schedules that yielded over $2.5 Million in additional contract revenue. • Established department guidelines for the inclusion of favorable operational terms (i.e. timely filing, timely payment, retrospective review and appeal rights) in all payor contracts. • Oversaw delegated credentialing negotiations. • Developed hospital and physician contract compliance program resulting in collection of over $8.7 Million in late payments/underpayments.

For-profit physician practice management & consulting firm specializing in hospital based physician services. Regional services included anesthesia, Radiology and Critical Care physician practices • Provided management leadership to finance, credentialing, and billing and collections teams consisting of three (3) collections supervisors and thirty-one (31) FTEs. • Directed the strategic plan for new business development and service line expansion. • Managed employment, compensation, incentive/bonus contracts for physician, CRNA, and support staff, and oversaw the funding of all pension/retirement accounts. • Negotiated managed care and indemnity contracts. • Coordinated all corporate, partnership and physician business affairs, including accounts receivable management, cash flow budgeting, physician and non-physician employee payroll, and accounts payable analysis.• Monitored and advised on corporate compliance initiatives.

Us

Not-for-profit, healthcare insurance carrier serving 700,000 subscribers in Northeastern Pennsylvania. • Managed day-to-day provider relations activities of eleven provider consultants and administrative personnel in the educations and enforcement of provider contracts and CMS regulations.• Reorganized the department to improve provider service efficiency to meet cost containment and business goals. Initiative resulted in HMO’s highest provider satisfaction rating since its inception.• Directly developed, negotiated, and implemented preferred and exclusive provider contracts. • Recruited physician and facility providers in Pennsylvania and New York State.• Developed and implemented Plan’s first RFP process for restructuring primary care and specialist physician, hospital, home health, and home infusion services networks. • Member of Plan’s credentialing committee. • Appointed as the Plan’s network management representative to the Blue Cross Blue Shield Association.

Ms, Health Administration

Bs, Business Administration And Management, General

Highschool, College Preparatory