Harry L. Duer

Resume of Qualifications

CELL PHONE 615-***-****

acuamj@r.postjobfree.com

www.duersconsulting.com

To Whom It May Concern:

Over the last 16 years I have worked either as an independent consultant or full time employee doing business healthcare networks and healthcare providers all over the country. My experience in developing MCO’s has led me to a deep understanding of many markets across the country. My methodologies in developing these networks are a 50% mix of virtual/ telephonic contact and negotiation and 50% traveling to conduct face to face meetings to close the deals. My meetings and recruitment targets include all specialties of providers, all types of ancillary facilities and hospitals. I have worked with various payers such as Guard Insurance, Majestic Insurance in introducing new products and services such as a one case contracting methodology and have drilled down past the payer level to service employer and TPA needs. I am also experienced in the various reimbursement methodologies such as Value Based contracting and Capitation. Couple those afore mentioned skills with a desire and a strong work ethic along with job and client ownership, you have a complete picture of my skills, background and viewpoint. I am interested in either consulting work or full time employment depending on the nature of the position or the project. Please contact me if there are any questions.

Sincerely,

Harry L Duer

Harry L. Duer

Resume of Qualifications

CELL PHONE 615-***-****

acuamj@r.postjobfree.com

www.duersconsulting.com

Education

Bachelors of Arts in Management / Human Relations, 1994 Trevecca Nazarene University, Nashville TN

Career Experience

Managed Care Contractor/ Business Development Consultant 2/08- to present

Market Intelligence Report Chiropractic- Mid West.

Market Intelligence Report Urology-NE.

Developed Medicare Advantage Network- FL.

Building a Clinical Integrated Network- NC.

Market Intelligence Report SW Homecare and Hospice.

Market Intelligence Report NE Women’s Health.

Market Intelligence Report Nursing - NE US.

Market Intelligence Report Toxicology Industry.

Market Intelligence Report Vein Industry- NE US.

Market Intelligence Report Nursing Care- FL.

HMO Network Development- NC.

Market Intelligence and contract review - CA Behavioral Health.

Market Intelligence report project- Florida PCP.

Market Intelligence report project- Florida Specialty Providers.

Home Infusion Non-Sterile Compounding Pharmacy business development.

Building Commercial Health Network- Chicago Illinois,

Marketed for durable medical O and P- IPA network.

Developed credentialing services network.

Developed dual eligible Medicare and Medicaid health network – TX

Developed dual eligible Medicare and Medicaid behavioral health network – TX.

Researched market for Medicare network- AR.

Pursued MA amendments for an ACO - OH.

Built Accountable Care Organization- GA.

Built Health Benefit Exchange – NY.

Built Medicaid expansion network in areas - KY.

Negotiated contracts for urgent care provider- TN and OK.

Negotiated contracts for provider group- FL.

Built MA (dual eligible) network expansion- AR.

Developed paper on Healthcare Exchanges in Georgia.

Developed talking points for contractors on Healthcare Exchanges.

Developed contracting implementation plan for SC and ID.

Built Medicaid expansion network- FL.

Worked LOAs for MFLAC program.

Built behavioral health network expansion- US.

Built worker’s compensation network expansion- SE US.

Staffing Recruiter for Medicaid expansion - KY.

Built Medicaid network expansion - OH.

Built Medicaid network expansion areas for RFP- TX.

Built Medicaid\ Medicare dual eligible network - SE. US.

Contracted multiple providers for commercial network development – GA.

Network Development, Operational and Account Management Consultant- IPS.

United HealthCare- Network Account Manager 5/09 to 2/10

Handled provider relations for over 3000 providers in the Middle TN area.

Build relationships with local providers in relation to United Healthcare Medicaid, Medicare, Tri-Care, and commercial products.

Assisted providers in analyzing claims, credentialing and data issues.

Analyze and solve data issues to ensure network integrity.

Negotiate and re-negotiate Medicare, Medicaid and Commercial contracts.

Research and solve internal network issues.

Educated providers on United Healthcare policies and procedures.

Concentra\Coventry HealthCare- Contract Manager- 12/2000 to 02/2008

Handled issues affecting network integration into Coventry’s network.

Responsible for network development of TN and KY commercial market.

Responsible for management of PTNet national network, marketing and provider/ client relations and building referral streams through central call center.

Conducted training on the PTNET product with case managers and clients.

Assisted payers in dealing with analytical and legal issues concerning MPN (California), HCN (Texas), MCO (Kentucky), Florida, PTNET and other network development issues.

Worked with delegated credentialing team to correct network issues nationwide.

Contracted 7000 plus providers hundreds of medical facilities and 35 hospitals.

Handled Focus network national contracting duties.

Managed recertification of Concentra’s Kentucky MCO.

Cleaned up contractual issues with California PT Net program and broad based PPO while adding providers for deeper discounts and better market penetration.

Built multiple MPN networks in CA in accordance with CA-Senate bill 899.

Successfully built over 25% of HCN network (TX) for Concentra network in accordance with House Bill 7 while acting as liaison for management in resolving payer, provider relations, billing and language issues.

Trained Beech Street personnel during network integration with Concentra.

Worked National Projects for Medicare Medicaid Network Expansion.

References available upon request

Contact this candidate