Thomas Killian Email & Phone Number

Indianapolis, Indiana, Us

Health Insurance/ Managed Care

Indianapolis, Indiana, Us

• Oversee the Provider Economics function supporting the Medicaid and Medicare lines of business of Anthem. This includes oversight for all unit-price trend analysis and forecasting of over $25B in provider payments. • Direct and oversee all provider contract and pricing analysis in support of Cost of Care strategies, State Medicaid reimbursement policy and methodology analysis and Medicare methodology analysis. • Manage the reporting and analytics function supporting all Shared Savings and quality based reimbursement programs. This includes the process and production of monthly, quarterly and annual reconciliation reporting to evaluate medical cost and quality performance for Shared Savings, provider quality incentive and risk based arrangements. This function supports over 200 value-based arrangements for providers with over $3 billion in annual spend. • Member of the Provider Management Analytics executive leadership team which set strategy and product design for all provider analytical functions with Anthem. • Lead the Contract Compliance Analytics function for the Government Business Division, which monitors and analyzes inaccurate contract pricing configuration and State reimbursement policy application. The unit’s analytics identified over $15M in claims recovery from overpayments and remediation of contract pricing errors resulting in $12M in cost avoidance.

Indianapolis, Indiana, Us

Chief Operating Officer for Amerigroup Kansas (a unit of Wellpoint's Government Business Division), one of three Medicaid health plans managing the State of Kansas KanCare program. Health plan size is approximately 125,000 members and $650 million in annual premium revenue. Responsibilities include: managing health plan provider relations, provider network management, health plan credentialing and local health plan operation staff. Also responsible for managing relationships with corporate shared service partners in claims operations, credentialing, provider network vendors, information systems support and system configuration of provider contracts and member benefits. From October 2012 through February 2013 led the health plan finance and reporting department.

Virginia Beach, Virginia, Us

• Managed Provider Network Pricing unit of Health Care Economics division. Direct provider contract analytics and provider pricing strategy for 16 markets with over 600 hospitals, 90,000 physicians and 7,700 ancillary providers.• Managed process to calculate, track and forecast hospital, physician and ancillary components of unit cost budget worth over $4.0 billion of AMERIGROUP’s medical cost budget. • Engaged directly with health plan executive teams on setting provider network pricing and contracting strategy and managing unit cost budget. Provide strategic pricing recommendations to health plan and corporate management. Primarily responsible to identify unit cost budget risks to AMERIGROUP corporate management. • Directed analytical review and pricing negotiations of all hospital/health system contracts greater than $10 million in payments. • Managed analysis of State Medicaid payment methodologies for existing AGP markets and potential new market development along with Center for Medicare/Medicaid Services. • Managed analytical process of national vendor agreements with dental, vision, dialysis, home health/therapy and transportation vendors. • Member of AMERIGROUP Reimbursement Policy Committee and Vendor Selection Oversight Committee. • Member of Health Care Economics leadership team reporting directly to Senior Vice President.

Virginia Beach, Virginia, Us

- Managed Provider Economics department with responsibility for provider contract analysis and provider analytics for all network providers. - Provided analytical support and recommendations to health plan leadership for setting annual network management strategy and unit cost tracking. - Led the provider economics review process to verify correct pricing configuration in claims system. Provider economics team identified over $2 million in pricing overpayment. - Member of Amerigroup's Reimbursement Policy Committee.

Virginia Beach, Virginia, Us

- Oversight of provider contract analysis and unit cost forecasting for provider across 10 markets. - Managed medical finance oversight for provider contract rate sheet approval and development process. - Developed concept and framework for unit cost tracking and reporting tool. Managed project team to develop reporting requirements and reporting tool layout. - Performed pricing methodology research, analytics and unit cost pricing models for new market network development. - Performed contract auditing that identified over $500,000 in contract overpayments. - Member of Amerigroup's Reimbursement Policy Committee.

Virginia Beach, Virginia, Us

- Managed provider contract analysis function for multiple markets in Medical Finance division. Initially performed function for 3 markets which grew progressively to 14 markets in 2007. - Managed transition of department from Medical Finance division to Healthcare Delivery Systems division in April 2006. Performed pricing analysis and claims data analysis of all providers including hospitals, physicians, ASCs, urgent care centers, dialysis, home health/home infusion and skilled nursing facilities. - Manage risk management process to perform financial analysis and present provider contract rate terms to senior management for full risk capitation contracts. - Acted as departmental contact for working with internal audit on establishment of departmental processes to establish controls as part of company's Sarbanes Oxley risk management process review. - Responsible for writing financial terms for contract rate sheets and working with claims system's team on translation of business terms into system configuration. - Provided analytical support and recommendations for health plan leadership for setting annual network management strategy.

Kansas City, Mo, Us

- Senior contract analyst for BCBS of Kansas City provider network operations. - Responsible for performing all provider contract analysis and provider network profiling analysis.- Managed transplant pricing arrangements including local transplant agreements, single case pricing and national transplant agreement with Blue Quality Centers for Transplant.

New Orleans, Louisiana, Us

- Performed role of managing provider relations and network contracting for three service regions in the New Orleans metropolitan area. - Lead negotiator for provider contracts representing over $30 million in annual provider payments. - Managed and executed Ochsner Health Plan's network development in response to State of Louisiana's planned implementation of Medicaid Managed Care pilot program.

Rolling Meadows, Illinois, Us

- Staff consultant performing health care research, strategy analysis, project management and report writing for hospital, health system and employer wellness program projects. - Managed firm's research library resources and financial budget.

Master'S Degree, Health/Health Care Administration/Management

Bachelor'S Degree, History