Durham, North Carolina, United States
An executive healthcare leader with extensive experience directing commercial and government provider network and provider contracting functions. Polished professional with superlative communication and interpersonal skills complemented by persuasive negotiations talents. Exceptional skills including successful all-provider type contract reimbursement negotiations, project management, creative problem solving, developing and maintaining effective working relationships with healthcare system senior leadership to achieve results despite significant challenges. Focused on accuracy, quality, and compliance while lowering health care costs. A strong collaborator and trusted advisor to business leaders and employees at all levels. I have been fortunate to have played a role in many of the major changes in the health care payer system. Specifically, from the introduction of HIPAA, to the implementation of Consumer Driven Health Care and price transparency, to the passage and launch of the Affordable Care Act (ACA), and the development of value-based contracting. I have strong analytical and negotiation skills, and I am passionate about building and fostering payer/provider partnerships, value-based care, and medical/administrative cost management.
Provided overall leadership and strategic direction over the contractual and service relationships of BCNC's statewide commercial and government provider networks of 30,000 hospital/physician/ancillary providers representing $18 billion in annual provider payments. Served as BCNC's executive to the provider community to develop successful provider/payer partnerships to develop innovative solutions to drive growth and lower costs. Directed all provider contract negotiations, including financial modeling, analysis and performance, and optimization of terms and conditions to enhance contract performance and outcomes. Implemented new provider reimbursement methodologies to support partnership opportunities, including ACO contracts, shared savings contracts, bundled payment arrangements, narrow and high-performing networks, and performance-based reimbursement. Designed, negotiated, and implemented new value-based networks to offer high-quality and low-cost products to promote product affordability and support corporate financial growth targets. Achieved $200M in annual cost savings associated with medical expense savings, quality improvements, and cost reduction trends. Motivated a team of 200 employees, committed to excellence in the areas of contract negotiations, provider service, provider engagement and network operations. Directed provider relationship management and engagement teams to cultivate and improve provider performance in value-based reimbursement models, improve provider satisfaction, and address provider inquiries. Advise internal leadership regarding the provider perspective, solicit input from the provider community to focus on strategic initiatives, and collaborate with all internal business units, clinical teams, operational areas, and legal departments to resolve complex provider issues.
Developed and maintained the most comprehensive provider network, which meets all access standards, high performance quality criteria, and corporate financial objectives. Developed per-unit reimbursement targets to develop plan premiums to ensure cost-effectiveness. Maintained contractual relationships with hospitals, physicians, and ancillary providers for all managed care products to resolve operational issues and contractual issues. Conducted strategic analyses to simulate proposed medical expense changes and project the desired medical expense results for contracting initiatives. Crafted comprehensive and strategic negotiation plans for each negotiation.