With more than 20 years of experience in the health insurance industry, this consultant has extensive provider network development, network compliance, credentialing and claims skills. In addition to start-up and established health plan experience, this professional has performed end-to-end new network builds, expansion efforts and re-contracting initiatives.
In his most recent role, our expert was responsible for the provider operations department of a national Medicare Advantage Institutional Special Needs Plan (ISNP) startup. He supported the establishment of new network builds in eight states. Further, he renegotiated established contracts to better align with the company’s financial goals and utilization.
While responsible for network development, provider relations and credentialing departments, our consultant managed a team of 23 employees and developed workflows, policies and procedures. In this project, he managed the strategy and expansion of the Medicare Advantage, ISNP and MLTC network to improve access for members and improve network adequacy.
Leverage this consultant’s expertise for your next project.
