Terry J. Email and Phone Number

• Develop, support, and grow existing and new business partnerships through outreach, education, and negotiation.• Work with Executive Leadership, Business Analysts, and Revenue Cycle Leadership to negotiate and optimize medical contracts.• Establish and maintain relationships with insurance, hospice, and other medical contract representatives, provider groups, and health systems.• Communicate changes and updates with insurance contracts with company leadership, branch locations, and Norco Qualification/AR teams.• Stay current and help maintain updated fee schedules for all necessary insurance providers.• Work closely with Revenue Cycle Leadership to identify opportunities, improve efficiencies, and correct payment errors between Norco and our various payers.• Analyze and share company specific metrics and build internal and external reports to share with insurance companies to build loyalty and increase engagement.

• Develop and maintain a cost-efficient network of contracted providers for each BCI product to meet the needs of our BCI membership. • Proactively identify provider payment or utilization variations and take action accordingly to solve for and communicate to leadership.• Identify strategic opportunities to realign standard and/or complex contracts to value-based arrangements and monitor the financial performance of such contracts.• Partner with internal key stakeholders to prepare and present financial performance reports on assigned contracts to leadership. • Formulate, analyze, coordinate and negotiate contracts with large healthcare systems and provider networks.• Leverage utilization, financial, clinical, and benchmark data from multiple sources to assist in the development, deployment, and performance measurement of innovative payment initiatives and methodology.• Negotiate agreements that maximize claims efficiency through auto adjudication. Work closely with Facets configuration analysts to structure contract terms to meet system processing requirements.• Implement contract language that meets the needs of internal business partners. • Serve as point of contact for assigned provider types to communicate any problems, issues, and/or questions to address with appropriate internal department within a timely manner and work towards resolution of any questions and/or issues.• Maintain active communication with the various provider communities that promote positive collaboration. Respond in a timely manner to provider requests for information regarding company contracting programs. Share information and data that target ways to improve health, expand coverage and minimize cost.

• Negotiate Provider Agreements with the various Insurance Carriers, Managed Care Organizations, Third Party Administrators, Direct Facility Plans, Hospital Physician Organizations, Accountable Care Organizations and Governmental Plans for Hospitals, ASC, IDTF, Cancer Treatment Centers, Specialist Clinics and PCP Clinics.• Experienced with Ancillary Contracting, Capitated Payor Contracting, Risk Management Contracting and Quality Measured Incentive Based Contracting. • Collaborates strategic initiatives with VP of MCO and Executive Leaders for revenue growth, care management opportunities, narrow network participation and Provider retention thru incentive based programs.• Decision Support “Know the Business” - provides monthly analytics of contract performance, patient retention, revenue measurement by financial class and Payor mix, variance reports, estimated PMPM for both commercial and governmental plans, credentialing and service points of access.• Actively involved in ACO startup project, payor performance analytics and internal communication plan of Payor specific performance.• Provides INN and OON clarification throughout the organization to prevent problematic claims issues, patient complaints, missed performance metrics for quality and efficiency measures. • Assist billing company and revenue cycle management team with claims error resolution for denied claims, overpaid claims, underpaid claims, OON claims and incorrect fee schedule loads.

•Experienced with Ancillary Contracting, Capitated Payor Contracting, Risk Management Contracting and Quality Measured Incentive Based Contracting. •Negotiate Provider Agreements with the various Insurance Carriers, Managed Care Organizations, Third Party Administrators, Direct Facility Plans, Hospital Physician Organizations, Accountable Care Organizations and Governmental Plans currently for multiple states. •Analyze significant and/or unique contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedures.•Identify needed changes to terms and conditions, statement of work, cost, and timeliness or other key con-tract elements and articulate said changes to the internal/external customer. •Analyze billing/revenue data for multistate comparable market rates, either a % of Billed Charges, price per unit or Flat Fee, to propose for all Payors.•Knowledgeable with the Neurodiagnostic billing and applicable modifiers for Current Procedural Terminology (CPT) values.•Knowledgeable recognition of common insurance plans (i.e. HMO, PPO, POS, Primary Plans, Complimentary Plans, Secondary Plans, Medicaid, Managed Medicaid Plans, Medicare, Medicare Managed Plans, Medicare Advantage Plans, Champus/Tricare, Champus VA, CHIP/Star/Star Plus, County Indigent Pro-grams and Workers Compensation).•Extensive knowledge in drafting contracts, understanding of contract and amendment language.•Assists the Business Development team to identify and gather Payor information as it pertains to new territories and completes CMS filings •Oversees the completion of facility and physician credentialing applications, re-credentialing, new state li-censing and renewals for Telemedx and any other entities deemed necessary by the organization

•Prioritize network needs both quantitatively and qualitatively •Strategically approach the behavioral health large provider groups, facilities and solo physician and ancillary provider community, and negotiate contracts that are favorable to LifeSynch’s business•Function as the single point-of-contact for all on-going contractual and service issues as needed by behavioral health providers and facilities. •Facilitate provider education, training them in order to increase their familiarity and satisfaction with LifeSynch’s systems and strategies. •Create trend analyses and summaries for decision-making purposes. •Interface with market leaders to align contracting needs and business efforts. •Strategically manage the Indiana and Ohio behavioral health network to ensure access and accessibility guidelines for Medicare filing are maintained.•Provide network insight and work alongside other departments when implementing new products or merging into new market areas.•Strategically set bench marks to reach the annual cost savings goals.•Retain CAQH documentation and submit within internal systems for provider credentialing•Utilize internal and external computer systems to conduct in depth analysis of provider claims data

•Experienced with Ancillary Contracting, Capitated Payor Contracting, Risk Management Contracting and Quality Measured Incentive Based Contracting. •Negotiate Provider Agreements with the various Insurance Carriers, Managed Care Organizations, Third Party Administrators, Direct Facility Plans, Hospital Physician Organizations, Accountable Care Organizations and Governmental Plans currently for ten states (AL, IN, KS, KY, MA, OH, OK, PA, TN and TX). •Analyze significant and/or unique contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedures.•Identify needed changes to terms and conditions, statement of work, cost, and timeliness or other key contract elements and articulate said changes to the internal/external customer. •Analyze billing/revenue data for multistate comparable market rates, either a % of Billed Charges, price per unit or Flat Fee, to propose for all Payors.•Knowledgeable with the American Society of Anesthesiologists (ASA) concurrency modifiers, utilizing the Relative Value Guide (RVG) for Current Procedural Terminology (CPT) values.•Knowledgeable recognition of common insurance plans (i.e. HMO, PPO, POS, Primary Plans, Complimentary Plans, Secondary Plans, Medicaid, Managed Medicaid Plans, Medicare, Medicare Managed Plans, Medicare Advantage Plans, Champus/Tricare, ChampusVA, CHIP/Star/Star Plus, County Indigent Pro-grams and Workers Compensation). •Assist with provider enrollment between internal and external clients.•Risk Management Specialist for all dental and medical malpractice claims.•Dental claim determination proposals and claim resolution release agreements with patients.•Medical Malpractice coordination between provider insurance carrier, counsel for provider, any/all providers involved and internal clients with privileged/confidential information access.

•Requested and retrieved all client records (Medical, Medical Billing, Pathology, Employment, Social Security, Union and Military).•Ensured all pathology was accurately sent, received and returned by HIPAA standards to experts for legal analysis.•Reviewed expert reports giving a summary to key points of notated information pertinent to the case. •Ensured all pathology was accurately sent, received and returned by HIPAA standards upon request from defendants.•Distributed correspondence internally regarding records as needed to the responsible attorney or paralegal assigned to the case to assist in the unneeded additions to the persons of knowledge roster.•Negotiated lien resolution pertaining to third parties involved (Medicare, Medicaid, Insurance, VA or Hospital Subrogation Claims).•Compiled all medical billing records to create a chronological summary to present at trial.

•Handled both internal and external client needs for the following projects: APIPA (AZ Medicaid/Medicare), UPHP (AZ Medicaid/Medicare), Maricopa (AZ Medicaid/Medicare), HCG (AZ Medicaid), Alabama Medicaid, Connecticut Medicaid, NJ Medicaid and WV Medicaid. •Attended on-site client meetings to provide detailed status reports on the progress of recoveries and case management policy/procedure changes or updates.•Experienced in navigating state MMIS systems with three plus years in Medicaid/Medicare Recovery.•Clear understanding of probate laws as they apply to the Texas Department of Aging and Disability Services.•Supervised the implementation of policy/procedures for the Medicaid Estate Recovery Program.•Daily tasks included asset verification, probate research, drafting correspondence, drafting legal documents and the supervision/management of staff (included delegating daily or specific project duties as needed).