BRIAN CASABAL

**** *. *********** ****, ***. ***

Glendale, AZ 85306

949-***-****

acvmrf@r.postjobfree.com

EXPERIENCE

TRIWEST HEALTHCARE ALLIANCE; Phoenix, Arizona 9/2014 to Present

Provider Contracting and Education Representative (Began as Contract Specialist)

Helped build network of Hospitals, Surgery Centers, Primary Care Physicians, Specialists, and Ancillary providers for provider network utilized by the U.S. Department of Veterans Affairs.

Managed relationships with various health plans in several states, who served as network subcontractors, including assisting in provider recruitment activities through identifying network shortfalls.

Negotiated and drafted agreements with non-contracted providers who had claims with the company resulting in significant cost savings over paying regular non-contracted rates.

Worked with Legal Counsel on processing proposed redlines in agreements.

Assisted providers in resolving contracting, credentialing, and claims issues by working with other departments in the company.

VARIOUS ORGANIZATIONS 01/2014 to 08/2014

Held several temporary positions in preparation for relocation outside of Orange County, California. Positions provided experience in preparing homeowner association documents for escrow closings, homeowner association elections, legally mandated notice distributions, and records archival.

PROSPECT MEDICAL SYSTEMS; Santa Ana, California 2012 to 2013

Contract Administrator

Maintained and built network of Primary Care Physicians, Specialists, and Ancillary providers for managed Independent Physician Associations (IPAs). Also, recruited physicians for hospitalist group that promoted quality care and cost savings encouraged by Affordable Care Act. Negotiated agreements that resulted in significant cost savings for IPAs.

●Identified IPA needs and recruited providers through telephone and mail recruitment.

●Produced contract documents, including fee for service agreements, capitation agreements, amendments, and Memorandum of Understandings (MOUs).

●Drafted termination letters to providers terminated from network.

●Worked with Credentialing Department to obtain credentialing documents by following up with providers and network managers.

●Prepared and submitted requests for financial analysis to Finance Department to prepare for negotiating contracts and amendments to existing contracts.

●Negotiated and drafted MOUs (Patient Specific) with non-contracted providers for urgent referral requests from Medical Management, Provider Dispute Resolutions, and balance bill issues for members.

BRIAN CASABAL 949-***-**** Page 2 of 2

APRIA HEALTHCARE; Lake Forest, California 2010 to 2012

Contract Specialist (Contract Position)

Customized boilerplate nursing agency, pharmacy (first dose), and respiratory education agreements and amendments based on Medicare regulations, Deficit Reduction Act, state laws, and company needs. Drafted externship and internship boilerplate agreements and amendments between company and colleges. Prepared provider credentialing applications, including obtaining licenses, surety bonds, and site survey reports for Medicare and state agencies.

SUMMIT CONSULTING INTERNATIONAL; Irvine, California 2007 to 2009

Litigation Document Project Manager

Performed document review of various litigation-related documents, including contracts, correspondence, daily reports, engineering reports, contractor reports, and submittals. Analyzed contractor invoices for litigation. Supervised claims coding and data entry for litigation project, including evaluating performance of personnel. Communicated project labor needs with employment agencies. Trained personnel for project, utilizing Concordance document management program and Microsoft Access. Conducted document searches on Concordance.

VARIOUS ORGANIZATIONS 2004 to 2007

During school, held mostly contract positions in the legal field. Positions, included assisting title companies with document retrieval and law firms with discovery index.

SILVA, CLASEN & RAFFALOW; Long Beach and Santa Ana, California 2003 to 2004 Paralegal (Contract Position)

Drafted responses to Form Interrogatories, Demand for Production, Request for Admissions, and Special Interrogatories for insurance company’s in-house law firm. Interviewed clients in preparation of discovery responses. Prepared Motion to Consolidate Cases and Motion to Tax Costs, among others. Conducted research for attorneys utilizing Lexis Nexis. Prepared subpoenas and interviewed witnesses for small claims cases. Representative for insurance company in small claims court, including making arguments in court, preparing briefs, and gathering evidence.

EDUCATION

Master of Business Administration, 2006

University of Maryland, University College; Adelphi, Maryland

Master of International Management, 2006

University of Maryland, University College; Adelphi, Maryland

Juris Doctor, 2000

California Western School of Law; ABA/AALS; San Diego, California

Paralegal Studies Certificate, 1997

California State University; San Bernardino, California

Bachelor of Arts, Criminal Justice, 1997

California State University; San Bernardino, California

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