San Francisco, California, United States
My career path has taken me through every major aspects of the healthcare industry throughout California. This includes upstream/downstream contract negotiations (hospital, ancillary and professional) and managing teams that are responsible for network development and contracting efforts along with the on-boarding/physician credentialing processes. In addition, I have an in-depth knowledge of both independent community based hospitals and multi-physician disciplinary, multi-hospital health systems and the important roles these health systems provide for the communities they serve. Throughout the course of my career, I have maintained the highest level of oral and written communications with payors, providers, all levels of internal staff, and other professionals, This has led to strong relationships and mutual respect with internal and external clients.
Lead negotiator for downstream hospital contracts in Los Angeles and Orange County . The contracts negotiations included, DRG, ffs per diems, case rates, and capitated reimbursement methodologies with an annual AR of $900 million.
I was brought in as an interim director (consultant) to rebuild and manage the department responsible for new physician hire on-boarding/off boarding process and human resource responsibilities.
Managed a team of four direct reports and four indirect reports. Established and managed annual financial budget for the Network Development and Credentialing departments. Lead negotiator for all downstream hospital and health system contracts where Brown & Toland Physician Services assumes financial risk. Strategic lead for new provider (physicians and facilities) recruitment efforts. Monitored and implemented workflow changes from financial and clinical reports that identified positive and/or negative trends with the physician and ancillary provider networks. Lead executive to monitor and maintain network adequacy for full and shared risk Commercial and Medicare Advantage products in licensed counties. Lead point of contact for new health plan product roll-out to provider network. Initiated and implemented process improvements (standard contract boilerplates usage, E-Signature, and online credentialing processes) for all downstream providers (physician and facility/technical) with Brown &Toland Physician Services.
Negotiate fee for service and capitated contracts for John Muir Hospital and John Muir Physician Network with national and regional health plans. Manage the day to day business relationship with contracted health plans. Monitor and report out the financial performance of the contracted health plans. Negotiate and manage down-stream contracts for John Muir Health’s ancillary network.
Managed a staff of six direct reports. Established and managed annual financial budget for the Regional Contracting and Credentialing departments. Lead director for new physician practice acquisitions and new physician on-boarding process for Sutter Pacific Medical Foundation. Lead strategist for potential clinical outreach growth expansion initiatives. Lead Contract Negotiator for upstream/downstream managed care contracts (Payor, facility, ancillary and medical groups) for Sutter Bay Region (Nine hospitals and three physician foundations) . Lead managed care liaison for regional non Sutter Health medical groups and IPAs. Regional implementation lead for new healthcare ACO and capitated managed care product rollouts. Regional liaison for Sutter Health system wide contracting initiatives. Establish and manage tertiary service case rates for self pay and international patient referrals.