Ryan Dukes Email & Phone Number

Denver, Co, Us

Greater Denver Area

• Manage provider accounts and relationships in Western Colorado including negotiating fee schedules, rates, contract terms and serving as a liaison between Anthem and providers by resolving any contractual, billing, administration, or service related issues• Negotiate new and existing agreements since joining Anthem, including contracts • Build new Anthem networks in Colorado to reduce member rates while ensuring and expanding Anthem’s presence, competitiveness and affordability in the Marketplace • Partner with Anthem Sales Department on business development and network expansion opportunities by identifying and prioritizing markets and employer groups where Anthem has the greatest opportunities for network expansion • Analyze various data sources, including provider metrics, Tableau reports and claims data to identify trends, opportunities, and issues relating to rate consistency, network adequacy and ultimately finding alternative avenues of saving money

Charlotte, North Carolina Area

- Administer and manage the portfolio of managed care agreements for CHS- Create new amendments and oversee the implementation process for all new or renegotiated managed care agreements- Monitor, report, resolve and prevents any operational issues related to existing managed care contracts- Interact with CHS revenue cycle staff and MCO provider relations to resolve any trended or escalated operational issues that arise during the term of the contract- Maintain current detailed working knowledge of all assigned payor contracts, and manages all activities related to managed care contract administration and compliance including, but not limited to: Chargemaster Increases, Contract Rate Adjustments, Contract Critical Events, CHS Entity and Contract Database, Contract Summary Database, Revenue Cycle Resource and MHR document distributions

Greensboro, Nc

-Perform managed care contract, payment, and revenue analysis to identify and resolve recurrent problems and identify revenue opportunities.

High Point, Nc

-Manage patient accounts to ensure medical claims are being correctly processed and paid in a timely manner by ourinsurance companies, workers compensation companies and other entities

High Point, Nc

-Analyzed and negotiated current and potential managed care contracts and fee schedules with Managed CareRepresentatives-Managed new contract implementation and educated office staff on new contract terms and requirements-Prepared and presented financial analysis reports for current contract rates and potential contract rates-Audited reimbursements from payors to ensure correct payment for services

Greensboro, Nc

-Negotiated the most favorable fee schedules and amendments to contracts resulting in increased revenue-Performed credentialing for thirteen physician’s State Medical Licenses and Managed Care Contracts