Experience

Forefront Dermatology

• United States
• Medical Practices
• 500 - 600 Employee

• Vice-President of Payor Contracting

  • Sep 2016 - Present

  $400 million specialty physician group practice. High growth, private-equity backed. 375 providers located in 175 offices across 21 states + Washington, D.C.Report to CFO. Responsible for negotiation and maintenance of 300 health plan participation agreements. Includes commercial, Medicare Advantage, Medicaid managed care, Tricare, and health insurance exchange products.- Introduced discipline to contracting function, implemented standard processes & reference tools.- Identify strategic negotiation opportunities, develop standard presentation to health plans.- Negotiated 2.5% increase w/largest multi-state insurance co. in 2020, escalators over contract term.- Renegotiated two national contracts comprising 23% of total practice medical revenue in 2021.- Manage team including 2 contract managers and contract specialist; 96 documents executed in 2020. - Prioritize and direct negotiation of language terms and fee schedules.- Perform analyses and contract modeling.



DaVita Kidney Care

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Director of Payor Contracting

  • Aug 2006 - Aug 2016

  $8.5 Billion, Fortune 500 national health care company. Main focus is providing dialysis and related services to kidney failure patients. Merged with HealthCare Partners, the leading physician management company, in 2012.Report to VP of Payor Contracting. Led matrix team to analyze and implement contracts. Responsible for all contracts with health plans and other private payors for the northeast region. Includes market trends analysis, strategy and initiative development, effective negotiations and relationship management.Key Accomplishments:• Manage portfolio of 100+ agreements representing $346 million in annual revenue.• Exceeded targets every year, averaging $8.25 million increased revenue per year.• Developed sales lead and worked with a cross-functional team to negotiate & implement a Shared Savings Program with Highmark Blue Cross.• Earned Negotiator of the Year for 2008 & 2011; Core Value Awards in 2007 & 2008.



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Director, Professional Network Management

  • Jan 2005 - Aug 2006

  $111 Billion, Fortune 100 diversified health insurance and services company. Leading provider of health insurance for commercial, Medicare, Medicaid, and military market segments. Reported to VP of Professional Network Management. Formulated and executed strategies to control $2.1 billion in medical costs for laboratory testing in all settings. Managed staff of business managers and senior network account representatives. Key Accomplishments:• Led request for proposal process aimed at establishing new national and local lab contracts. Resulted in award of long-term national preferred contract and cost reduction of approximately 10%.• Orchestrated development of data interface application to capture and standardize lab test results. Enabled strategic vision of improving case management by increasing data capture and identification of targets.• Managed day-to-day support of eight national contracts.

• Director of Pricing, Ancillary Program Management

  • 2002 - Dec 2004

  Reported to VP of Ancillary Program Management. Directed all financial analyses for department that managed $11.8 billion annual spend. National scope position. Provided strategic and tactical advice, developed reporting tools, and modeled contract proposals for service line managers. Managed a staff of analysts.Key Accomplishments:• Served as member of unit’s senior management team. Participated in strategy development and identification of new opportunities. Represented unit in myriad cross-functional activities.• Designed and reported metrics to drive national initiatives to reduce the size of the network, migrate to standard contracts, and adopt standard fee schedules. Results included a 29% reduction in the size of the durable medical equipment, home health, and lab networks.• Directed or performed analyses for high-profile initiatives including contract negotiations with two national labs ($360+ million spend), radiology management, and chemotherapy drug management program.• Earned reputation across matrix organization as insightful and helpful subject matter expert. • Collaborated with inter-segment companies to manage programs for chiropractic care and dialysis.



Oxford Health Plans

• United States
• Insurance
• 1 - 100 Employee

• Director of Strategic & Financial Planning, Medical Affairs

  • Jun 1999 - Jan 2002

  $4.3 Billion in 2001, leading managed care organization in New York City tri-state market.Reported to Executive Vice-President/Chief Medical Officer. Wide-ranging role that supported strategic, financial, and operational needs of Medical Affairs division. Performed both analytical and operations roles.Key Accomplishments:• Guided Medical Affairs’ implementation of delegated contracts. Point person on contacts with external vendors for radiology, physical therapy, and post-acute care.• Managed White Plains, NY pre-certification call center. Directed staff of 40, including two supervisors. Center handled an average of 3,000 calls per day. Decreased average speed to answer by 63 seconds year-over-year. Developed performance standards and personnel policies.• Directed development of enterprise-wide medical cost reporting applications for both commercial and Medicare product lines. Utilized by senior management to measure viability of new utilization management strategy.• Conducted interviews, documented workflows, and performed data analyses for cross-functional quality improvement initiative for Medical Management. Processes of four offices were standardized into two offices.



Health Net

• United States
• Insurance
• 700 & Above Employee

• Director of IPA Management

  • Dec 1997 - Jun 1999

  Regional health plan operation - Health Net of the Northeast. 800,000 members across CT, NY, and NJ.Reported to Executive Director for New York. Established new position in company. Executed strategy to increase risk-sharing contracts with provider community in New York City service area. Key Accomplishments:• Negotiated full and shared-risk contracts with IPAs and PHOs to achieve cost reduction targets for both commercial and Medicare products. Made go/no go decisions on potential contracts.• Oversaw support of delegated risk contracts with five provider groups covering 52,000 commercial and 3,900 Medicare members. • Orchestrated delegation of claims payment function to an IPA.• Collaborated with medical directors and multiple departments to implement contracts and achieve goals.• Invited to speak at industry conferences as a result of my activity in the market.



Avanti Corporate Health Systems

• Medical Management/Contracting Analyst

  • Jun 1995 - Dec 1997

  Avanti was the physician practice management subsidiary of NYLCare Health Plans (New York Life’s health insurance subsidiary which merged into Aetna). It owned and managed 53 primary care offices in five regions across the country. All medical groups held risk contracts.Reported first to the President and then to the Chief Medical Officer in wide-ranging role responsible for operations analysis and development of medical cost reporting & contract management tools.Key Accomplishments:• Managed process of contracting specialty network ("wrap around IPA") for risk-bearing primary care groups. • Monitored in-network versus out-of-network utilization.• Created medical cost management reporting system to identify high cost categories, evaluate variability in practice patterns, and audit attribution of medical costs against risk pool.• Led national customer service initiative. Instituted performance standards, measurements, and surveys. • Analyzed physician scheduling and productivity.• Prepared budgets for physician practice operations in New York.