William Carboni's Location
Windham, New Hampshire, United States, United States
William Carboni's Contact Details
William Carboni work email
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About William Carboni
Experienced leader in Operations & Network Development with a demonstrated history of working in the hospital & health care industry. Skilled in Contract Management, Healthcare Reimbursement Methodologies, Business Process Improvement, Client Management, and Healthcare Financing.
William Carboni's Current Company Details
Compass Benefits Llc
A results driven professional with operations, network management, & team leadership experience.
William Carboni Work Experience Details
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Account ExecutiveCompass Benefits Llc May 2024 - PresentResponsible for selling and servicing Compass Benefit clients on life, accident, and health insurance products for individual and small groups. As a licensed NH Resident agent, my duties include:- Annual business plan development- Conducting annual educational benefit seminars for retirees and small groups- Qualifying leads for potential enrollment and determining the optimal plans to meet their medical and financial needs- Enrolling over 65 customers in Medicare Part C and D coverages, as well Medigap (Medicare Supplement) plan. - Providing small employer groups and individuals a suite of health and welfare benefits such as life, accident, health, annuity plans
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Sr. Director Of Network Strategy & ManagementHealth New England May 2023 - Sep 2024Springfield, Ma, UsResponsible for leading the network contracting and operations teams to build and maintain HNE’s network of providers to offer Commercial, MA Connector, MassHealth, and Medicare Advantage plans in Western MA under both FFS and the full breadth of risk sharing arrangements. These responsibilities include, setting network expansion strategy through direct or vendor agreements, medical unit cost budgeting for rate negotiations, establishing base fee schedules, provider benchmark analytics, as well as network operations process improvement and optimization. Functional areas encompass, Provider Contracting, Provider/Vendor Management, Credentialing, Provider Enrollment, Provider Relations, and Provider Appeals. -
Vice President Of Network Strategy And OperationsPoint32Health Jul 2021 - Sep 2024Canton, Ma, UsResponsible for overseeing payment integrity, network management and operations, provider relations and communications, provider information, ancillary contracting and enterprise network strategy. A shared service model servicing all lines of business - Medicare, Medicaid, and Commercial collaborating with product leaders, provider performance managers and network contracting teams within the lines of business. -
Independent ConsultantMazars Jan 2021 - Jul 2021Paris La Defense, FrMazars in the US is an independent member firm of Mazars Group, an international audit, tax and advisory organization with operations in over 90 countries. With roots going back to 1921 in the US, the firm has significant national presence in strategic geographies, providing seamless access to 24,000 professionals around the world. Our industry specialists deliver tailored services to a wide range of clients across sectors, including individuals, high-growth emerging companies, privately-owned businesses and large enterprise.Recruited and contracted for health plans with:• All provider types affiliated with hospital systems including; medical groups, ancillary providers, medical groups, solo practitioners.and clinicians.• Networks for products including dual-eligible Medicare/Medicaid HMO, Medicare PPO, dualeligible Medicare Advantage.• Regions covered New York Upstate & Downstate.• Expert in both facility and professional based Medicare & Medicaid reimbursement. -
Vice President Of Business DevelopmentDrexly Health Solutions Mar 2020 - Jul 2021Marketing & enrollment of providers in telehealth software platform as well as negotiating provider agreements on behalf of practices with insurance payers. Also marketing a Medication Assisted Treatment (MAT) telehealth portal & Network solution to insurance companies. • Partner with solo & group practitioners to establish telehealth needs & customize platform according to specifications.• Train providers & staff on platform operations as well as accessing & scheduling via the application. • Analyze provider reimbursement data in order to normalize fee structures & establish benchmarks.• Negotiate with regional & national payers on behalf of providers to increase fee schedules, value based purchasing opportunities, & Pay for Performance reimbursement methodologies.• Develop & validate prospect list of carriers with customer, present features & benefits of network as well as platform to C-Suite & front line representatives, & negotiate contract language & rates for portal services.
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Vp Of Network Development & Contract StrategyBeacon Health Options Oct 2018 - Mar 2020Boston, Massachusetts, Us• Built behavioral health network builds across the country for new business implementations.• Developed national rate & fee governance model to limit & monitor medical unit cost increases.• Standardized all operational procedures across the enterprise to increase efficiencies & reduce handoffs. -
Avp Of Network DevelopmentBeacon Health Strategies Jun 2014 - Oct 2018Boston, Ma, Us• Managed all aspect of a Behavioral Health network for MA, NH, RI, NY, TX, IL, KY, DC, PA, & CT.• Led a team of 3 Directors, 12 Network Managers, & 19 Provider Relations Representatives.• Primary Network contact for all health plan & employer customers in responsible states.• Completed the build of the HARP/QMP network in downstate & upstate NY for adults with a team of 5 network managers in 8 months. -
Director, Contracts & Provider RelationsConformis, Inc. Jul 2012 - Jun 2014Billerica, Ma, Us• Accountable for negotiating with Group Purchasing Organizations, hospital systems, DOD, & VA in the US, Germany & UK for custom made knee replacement systems that employ patented image to implant technology.• Developed national contracting strategy in collaboration with 10 Regional Sales Directors & the SVP of Sales.• Added 1,100 hospitals under contract or pricing terms in 14 months with marginal reduction in average sales price.• Contracted with Independent Representative Agencies as an alternative sales force & implemented an incentive commission plan for independent agents as well as Regional Sales Directors. -
Director Of ContractingAnthem Blue Cross Sep 2008 - Dec 2012• Accountable for contracting with hospitals, hospital owned physician practices, & large independent physician groups in NH, MA, VT, & ME.• Created new ambulatory surgical payment grouper based on RVU’s & added over 900 new CPT codes to fixed pricing methodology to alleviate claim denials.• Developed core set of queries for hospital utilization that identify ‘high bars’ in spending & targets for contract negotiations. Designated PE&C liaison to Sales for NH’s Site of Service initiative.
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Cost Of Care ConsultantAnthem Blue Cross Jan 2012 - Jul 2012Provided analytical support for the Provider Contracting department of Wellpoint’s State Sponsored Business division with a focus on lowering claims costs & improving the quality of care• Performed sophisticated retrospective data analytics for professional to control costs & project cost increases in medical services• Analytical leader on large scale initiatives with high dollar cost savings opportunities. • Managed the Accountable Care Organization (ACO) for Dartmouth-Hitchcock including, DxCG risk adjusted MCT setting, standard reporting package development, PPO attribution model, Quality & Efficiency scorecard development, & steering committee meeting participation.• Led contracting team in the annual statewide fee schedule development process.
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Director Of Provider RelationsBcbs Ma Jul 2007 - Sep 2008Led a team of 8 Provider Managers & 2 Provider Coordinators accountable for managing all aspects of the provider relationship with Hospitals, Groups, & Individual Providers.• Directed staff on project priorities &assisted with provider escalations.• Managed Pay-for-Performance programs for Facilities & Groups, including metric development, reporting, & incentive distribution.• Implemented BCBSMA tiered network plan design by reviewing tier methodology with providers, conducting outreach program to update data, & aiding providers in the appeal process.
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Director Client ServicesFidelity Investments 2000 - 2006Boston, Ma, UsManaged a Client Service Team to ensure the clients’ overall satisfaction with the quality & effectiveness of the Health & Welfare record keeping services.• Acted as the main point of contact to discuss strategic changes in business that impact the H&W organization & the administration of services.• Coordinate with Project Manager to ensure prioritization & timely completion of projects & system enhancements.• Manage overall project for Annual Enrollment of Health & Welfare benefits including, Communications, Systems, Phone Service Group, & Operations.• Prepared & presented quarterly, monthly, & weekly reports, including monthly invoice to client.
William Carboni Skills
Healthcare
Provider Relations
Managed Care
Hospitals
Medicare
Management
Health Insurance
Healthcare Industry
Leadership
Strategic Planning
Network Development
Health Policy
Medical Devices
Medicaid
Cross Functional Team Leadership
Process Improvement
Hipaa
U.s. Health Insurance Portability And Accountability Act
Contract Negotiation
Contract Management
Strategy
Provider Network Development
Provider Networks
Data Analysis
Project Management
Microsoft Access
Microsoft Excel
Business Process Improvement
William Carboni Education Details
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Holy Family UniversityMarketing/Management
Frequently Asked Questions about William Carboni
What company does William Carboni work for?
William Carboni works for Compass Benefits Llc
What is William Carboni's role at the current company?
William Carboni's current role is A results driven professional with operations, network management, & team leadership experience..
What is William Carboni's email address?
William Carboni's email address is wi****@****ons.com
What is William Carboni's direct phone number?
William Carboni's direct phone number is +161773*****
What schools did William Carboni attend?
William Carboni attended Holy Family University.
What skills is William Carboni known for?
William Carboni has skills like Healthcare, Provider Relations, Managed Care, Hospitals, Medicare, Management, Health Insurance, Healthcare Industry, Leadership, Strategic Planning, Network Development, Health Policy.
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