Alexander Price
Director at Lumeris- Claim this Profile
Click to upgrade to our gold package
for the full feature experience.
Topline Score
Bio
Credentials
-
Certified Dementia Practitioner
National Council of Certified Dementia PractitionersJan, 2014- Nov, 2024
Experience
-
Lumeris
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Director
-
Oct 2023 - Present
Assure smooth and efficient operations for Essence Healthcare and Lumeris. Ensure compliance and manage several key vendor partners. Develop and implement strategy across departments that align and support overall goals. Responsible for continuous process improvement and standardization around planning, implementation, and controls. Oversee multiple complex projects. Identify 3rd party vendors and manage relationships as it relates to direct logistics and cost efficiencies. Assure smooth and efficient operations for Essence Healthcare and Lumeris. Ensure compliance and manage several key vendor partners. Develop and implement strategy across departments that align and support overall goals. Responsible for continuous process improvement and standardization around planning, implementation, and controls. Oversee multiple complex projects. Identify 3rd party vendors and manage relationships as it relates to direct logistics and cost efficiencies.
-
-
-
UnitedHealthcare
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Associate Director of Network Programs
-
Jun 2021 - Oct 2023
•Manage UHN National Ancillary Network Support team (15) •Responsible for 25,000 contracts nationwide covering commercial & Government business •Serve as government program lead, representing department to organizational senior leaders & external clients •Ensure contractual & regulatory compliance for National Medicare & Exchange products; State-specific Medicaid products •Develop & drive strategy for network expansions, successfully delivering 10 Medicaid state-specific network… Show more •Manage UHN National Ancillary Network Support team (15) •Responsible for 25,000 contracts nationwide covering commercial & Government business •Serve as government program lead, representing department to organizational senior leaders & external clients •Ensure contractual & regulatory compliance for National Medicare & Exchange products; State-specific Medicaid products •Develop & drive strategy for network expansions, successfully delivering 10 Medicaid state-specific network rebids and expansions, & aggressive Exchange growth over the past 2 years, contracting over 3,000 providers •Champion & manage operational improvement processes between Network and national operations partners, focusing on contract load enhancements yielding a 20% improvement year over of submission timeliness and accuracy •Sustain & exceed service-level agreements for provider inquiry, requests to join network, and Regulatory/Executive complaint resolution •Oversight of network termination management; ensuring regulatory compliance with state-specific requirements, inclusive of member notification •Manage transition between contract drafting platforms, ensuring accurate outcomes, providing support and creation of tools to contracting teams •Deliver regular network status updates and business objective reporting to senior organizational leaders
-
-
Network Program Manager
-
Apr 2018 - Oct 2023
Lead contracting efforts for Property and Casualty Network Analyze provider data to identify and advance strategic initiatives such as workers’ compensation Create network initiatives training for cross-functional audiences Develop solutions and implement ideas impacting new products, market strategies, and business Establish nationwide virtual health initiative questionnaire Lead new business rate initiatives across all markets
-
-
-
Harken Health
-
Hospitals and Health Care
-
1 - 100 Employee
-
Network Program Consultant
-
Jul 2015 - Apr 2018
•Oversee provider data management and the integrity of the National Database data stream into Facets and public website search •Partner with the organization’s third party pricer (ppoONE) and Network Development Team to ensure provider record data is setup accurately and claims are processed per provider contracts. •Led migration of electronic fund transfer from Emdeon to InstaMed for Harken, while working with a dynamic group of individuals remotely to meet business needs •Manage… Show more •Oversee provider data management and the integrity of the National Database data stream into Facets and public website search •Partner with the organization’s third party pricer (ppoONE) and Network Development Team to ensure provider record data is setup accurately and claims are processed per provider contracts. •Led migration of electronic fund transfer from Emdeon to InstaMed for Harken, while working with a dynamic group of individuals remotely to meet business needs •Manage, train and audit offshore support team of ten through claims processing and network operations support functions; improving audit results from 8% success to 87% within three months •Direct identification and implementation of Facets configuration changes, ensuring system requirements reflect the needs of production team, coordinating changes with IT and Product •Evaluate requirement expectations and execute testing to ensure large configuration additions to add in a new network/product to the Facets platform are working as expected •Drove automization initiative for member notification of provider termination to ensure compliance with UHN requirements Show less •Oversee provider data management and the integrity of the National Database data stream into Facets and public website search •Partner with the organization’s third party pricer (ppoONE) and Network Development Team to ensure provider record data is setup accurately and claims are processed per provider contracts. •Led migration of electronic fund transfer from Emdeon to InstaMed for Harken, while working with a dynamic group of individuals remotely to meet business needs •Manage… Show more •Oversee provider data management and the integrity of the National Database data stream into Facets and public website search •Partner with the organization’s third party pricer (ppoONE) and Network Development Team to ensure provider record data is setup accurately and claims are processed per provider contracts. •Led migration of electronic fund transfer from Emdeon to InstaMed for Harken, while working with a dynamic group of individuals remotely to meet business needs •Manage, train and audit offshore support team of ten through claims processing and network operations support functions; improving audit results from 8% success to 87% within three months •Direct identification and implementation of Facets configuration changes, ensuring system requirements reflect the needs of production team, coordinating changes with IT and Product •Evaluate requirement expectations and execute testing to ensure large configuration additions to add in a new network/product to the Facets platform are working as expected •Drove automization initiative for member notification of provider termination to ensure compliance with UHN requirements Show less
-
-
-
-
Director
-
Sep 2012 - Jun 2015
Assure high standard of care for residents. Oversee daily operations. Responsible for selection, recruitment, training, certification, and in-services of caregivers, housekeepers, maintenance, and dietary employees. Ensure regulator compliance. Manage labor to accurately reflect the need of residents. Assure high standard of care for residents. Oversee daily operations. Responsible for selection, recruitment, training, certification, and in-services of caregivers, housekeepers, maintenance, and dietary employees. Ensure regulator compliance. Manage labor to accurately reflect the need of residents.
-
-
-
Oakwood Village
-
United States
-
Hospitals and Health Care
-
100 - 200 Employee
-
Administrator in Training
-
Aug 2010 - Aug 2011
Assist in the general leadership of the Skilled Nursing Facility, with emphasis on a coaching/partnership style which empowers the staff to be creative, to offer input into the decision-making process, and to develop as accountable members of the Oakwood team. Focus on the provision of high quality services for the residents and their families. Ensure prompt resolution of concerns that will result in resident/facility satisfaction. Work closely with Preceptor to gain… Show more Assist in the general leadership of the Skilled Nursing Facility, with emphasis on a coaching/partnership style which empowers the staff to be creative, to offer input into the decision-making process, and to develop as accountable members of the Oakwood team. Focus on the provision of high quality services for the residents and their families. Ensure prompt resolution of concerns that will result in resident/facility satisfaction. Work closely with Preceptor to gain experience in various aspects of skilled nursing administration. Show less Assist in the general leadership of the Skilled Nursing Facility, with emphasis on a coaching/partnership style which empowers the staff to be creative, to offer input into the decision-making process, and to develop as accountable members of the Oakwood team. Focus on the provision of high quality services for the residents and their families. Ensure prompt resolution of concerns that will result in resident/facility satisfaction. Work closely with Preceptor to gain… Show more Assist in the general leadership of the Skilled Nursing Facility, with emphasis on a coaching/partnership style which empowers the staff to be creative, to offer input into the decision-making process, and to develop as accountable members of the Oakwood team. Focus on the provision of high quality services for the residents and their families. Ensure prompt resolution of concerns that will result in resident/facility satisfaction. Work closely with Preceptor to gain experience in various aspects of skilled nursing administration. Show less
-
-
Education
-
2006 - 2011
University of Wisconsin-Eau Claire
Bachelors, Health Care Administration
Community
