Expert Details

Expert in Provider Relations, Operations, Provider Network Development, Provider Contracting

Expert ID: 728191 Pennsylvania, USA

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Expert has been involved in Provider Relations/Network Development and Operations in the Health Insurance Industry as an executive (VP/Manager), both domestic and international and is experienced in all aspects of contract negotiations. At one HMO he led the team efforts to successfully double the network in a highly competitive region where the company was one of the smallest players, with no substantial membership growth during the same time. He also worked as VP of Operation for a national PPO network where he successfully developed a full provider network (Hospitals, Physicians and Ancillary) in several states.

Having worked in network operations and provider relations for the past 15 years he has developed an extensive experience in performance improvements. This, combined with his vast IT knowledge has proven to be very valuable in being able to take complex problems and bring them down to a manageable size in order to formulate a plan of action.


He wrote the business plan for network development for a TPA in LakelandHe developed the network in 4 states for a national radiology planHe helped implement digital dashboards in various healthcare related facilities

Expert may consult nationally and internationally, and is also local to the following cities: Tampa, Florida - Saint Petersburg, Florida - Orlando, Florida - Clearwater, Florida - Cape Coral, Florida - Palm Bay, Florida - Lakeland, Florida - Melbourne, Florida - Deltona, Florida - Largo, Florida

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Education

Year Degree Subject Institution
Year: 1988 Degree: MBA Subject: Strategic Management Institution: Erasmus University/Rotterdam School of Management
Year: 1986 Degree: BA Subject: Criminology Institution: Florida State University

Work History

Years Employer Title Department Responsibilities
Years: 2009 to 2011 Employer: PARIM Title: Interim-Manager Department: Responsibilities: He developed Network Business plan for a Third Party Administrator in Lakeland, FL.
He served as Interim Operations Manager for Chakra Info Solutions, a physician software and billing company headquartered in Chennai, India, overseeing day and evening shift (total of 125 FTE’s).
Years: 2006 to 2009 Employer: AvMed Health Plans Title: Regional Manager Department: Network Contracting and Service Responsibilities: He oversaw network development, contracting and maintenance for 10 counties in Central Florida, managed, trained and coached 8 FTE's in two locations (Orlando and Tampa), responsible for P&L and departmental budgets and since March 2007 Acting Director for Central Florida Network Department.
Years: 2003 to 2005 Employer: HRS Associates Title: Trainer/Coach Department: Training Responsibilities: He coached executives of various companies in international business skills.
Years: 2001 to 2002 Employer: Keenan & Associates Title: Sr. Consultant Department: Responsibilities: Consultant to specialty radiology network.
Years: 1996 to 2001 Employer: Multiplan Title: Vice President Department: Southern Region Responsibilities: He oversaw daily operations of the hospital, physician and ancillary network for 15 states and Puerto Rico and the Virgin Islands and Directly managed four Regional Directors and 22 FTE’s.
Years: 2011 to 2013 Employer: Florida Blue Title: Senior Manager Department: Network Devekopment Responsibilities:
Years: 2013 to Present Employer: Undisclosed Title: Director Department: International Contracting Responsibilities:

International Experience

Years Country / Region Summary
Years: 2003 to 2005 Country / Region: Germany Summary: He conducted varous training sessions with business executives from various German corporations in both business skills and GMAT testing
Years: 1981 to 1982 Country / Region: The Netherlands Summary: He served with the Royal Netherlands Military Police
Years: 2013 to Present Country / Region: Worldwide Summary: He is currently the Director of International Contracting for GeoBlue, the international branch of Blue Cross Blue Shield, negotiating contracts and rates in all countries GeoBlue does business.

Career Accomplishments

Associations / Societies
MENSA
Toastmasters International
Licenses / Certifications
MHP - Managed Healthcare Professional
Professional Appointments
President Victory Toastmasters

Additional Experience

Training / Seminars
Instructor for GMAT
Training in business skills, sales and negotiations
Other Relevant Experience
Competent Communicator with Toastmasters International

Language Skills

Language Proficiency
Dutch Dutch is his native language
German He speaks and understands German very well
French He has a basic mastery of French
Spanish he speaks a little Spanish

Fields of Expertise

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