Experience

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  Boost Healthcare

  • San Francisco Bay Area

  • Principal

    • Sep 2015 - Present
    • San Francisco Bay Area

    Payer ContractingUnderpayment reviewDenial Management

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  Salem Health

  • Salem, Oregon

  • Director, Payor Contracting and Relations

    • Sep 2013 - Sep 2015
    • Salem, Oregon

    Responsible for health plan contracting strategy for two hospitals (DRG and CAH) and medical group and over $1 billion in net revenueMaintained positive net revenue increases in excess of 3% in on all contract renewalsCreated policies and procedures that standardized contracting processesManaged two Senior Contract and Relations SpecialistsNegotiated full risk contract with the regional Coordinated Care Organization (CCO) worth over $100 million in gross revenueDeveloped strategy for moving contracts away from fee for service to population based (risk) contractsServe on regional Coordinated Care Organization contracting committee for the health system to provide oversight to the networkAssisted the organization in the financial development of a Clinical Integration NetworkDeveloped bundled payment strategy through the CMS Bundled Payment Initiative

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  Humana

  • Portland, Oregon

  • Hospital Contracting Executive

    • Apr 2012 - Aug 2013
    • Portland, Oregon

    Develop network strategies for Accountable Care Organizations, Pay for Performance, risk based and medical home contracts to increase market penetrationResponsible for contracting with health systems, hospitals, IPAs, and large groups in the states of Oregon and WashingtonDeveloped a Medicare network expansion plan for the State of Oregon and Washington in compliance with Medicare’s HSD requirementsResponsible for $100 million in government claims expenditures and contracts in Oregon and WashingtonMentored junior contractors in expansion strategy and network developmentLed cross-functional teams in risk group development and contract implementation deployment processes and projectsServed as point of contact for senior leadership in Oregon and Washington for personnel changes in the absence of director and field vice presidentDeployed gain sharing and risk contracts for large medical groups, IPA’s, and health systemsCounseled junior contractors on their performance and help set contracting targets and strategies

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  The ODS Companies

  • Portland, Oregon Area

  • Senior Contract Negotiator

    • Aug 2010 - Mar 2012
    • Portland, Oregon Area

    Effectively negotiated competitive rates for membership via large clinic and hospital contracts to achieve $4.5 million in cost savings to date or negative 4% per agreementResponsible for $250 million in claims expenditure’s for health systems and large medical groupsDeveloped network strategies for Accountable Care Organizations, Pay for Performance, and medical home contractsDeveloped processes for auditing and loading contracts into FACETS claims systemLead organizational initiative to move contracts to standard CMS fee schedules for ASCs, HHs, and SNFsCreated and implemented a Pay for Performance contracts for commercial productsMentored junior contractors on effective problem solving, contract negotiation, and strategy developmentEstablished and maintained more than 1,500 contractual relationships with the provider communityProblem-solved and negotiated claims issues to achieve positive mutual outcomes

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  PacificSource Health Plans

  • Bend, Oregon

  • Provider Relations and Network Development Represenative

    • Jun 2007 - Aug 2010
    • Bend, Oregon

    Established and maintained over 250 relationships with the provider communityEffectively problem solved and negotiated claims issues to achieve positive outcomesNegotiated and interpreted contracts to build a Medicare adequate network of providersTrained clinical staff on new software releases and developed processes for online registrationDeveloped training manuals for new provider portal and performed ongoing education of service enhancementsMentored peers in relationship building techniques and conflict resolutionConsulted customer service on escalated provider and member issues regarding complex claims, authorization, and grievance and appeals Deployed medical management initiatives to strategic partners in the community

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  Oregon Youth Challenge Program

  • Bend, Oregon

  • Lead Group Life Coordinator

    • Jul 2003 - Jun 2007
    • Bend, Oregon

    Responsible for the safety and welfare of 120-150 at risk youth, training and development, and direct supervision of three employeesEvaluated three employees on their performance on a weekly basisConducted annual performance reviews for three employeesResponded to disciplinary problems in an expedient and compassionate mannerDeveloped standard operating procedures to enhance the effectiveness of the work environmentMaintained high levels of accountability for 120-150 at-risk youth

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  United States Marine Corps

  • Camp Lejeune, North Carolina

  • Marine

    • Oct 1998 - Jul 2003
    • Camp Lejeune, North Carolina