Network Development Consultant
Resume:
Anthony Mungen
Buffalo, NY *****
*********@*****.***
Network Development and Provider Relations professional looking to secure a position where I can apply my twenty years of healthcare experience to support corporate growth.
Profile
Over twenty years in the healthcare field, primarily developing provider networks and educating providers
Strong ability to communicate with all levels of management
Ability to direct complex projects from concept to operational status
Goal oriented individual with strong leadership capabilities
Highly organized and detailed problem solver
Proven ability to work collaboratively with staff, internal and external customers
Relevant Experience & Accomplishments
Successfully built Networks for all lines of business (including Dental) in Pennsylvania, Arkansas, Colorado, Connecticut, Florida, Georgia, Kentucky, Ohio, Maryland, New York, New Jersey, North Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Oklahoma and Wyoming,
Negotiated competitive reimbursement rate with non participating provider and provider groups
Strategically recruited and contracted a network of Urgent Care Centers, lowering the health plan’s ER utilization costs
Successfully renegotiated the contracts for the North Shore Hospital systems, reporting directly to the VP of contracting
Successfully oversaw the credentialing process for 250 physicians that were presented to the credentialing committee for approval
Successfully renegotiated the Facility Contracts for Planned Parenthood Inc
Successfully contracted and negotiated rates for ancillary facilities for MLTC network
Successfully recruited and contracted network of ambulatory surgical centers
Successfully negotiated single case agreements with out-of-network providers
Professional Experience
The Viability Company, (Contract Position) Network Development Consultant
January 2022 – August 2023
Recruited and contracted hospitals, medicals groups facilities for Medicaid expansion in Iowa
The Populus Group, (Contract Position) HCSC – Network Development Consultant
October 2022 – July 2023
Recruited and contracted hospitals, facilities for Medicare DSNP in Illinois
TOG Network Solutions – Hospital Contracting Executive (Contract Position)
March 2022 – Sept 2022
Recruited and contracted hospitals and facilities for the Medicaid LOB expansion
Ewings Provider Network Solutions (Contract Position) Network Development Consultant
January 2021 – June 2022
Recruited and contracted physicians, hospitals, mental health providers for the HealthCare Exchange Network.
Essential HealthCare Solutions (Contract Position) Network Development Consultant
November 2020 – March 2021
Recruited and contracted physicians for the VA Disability Specialty Network
Negotiated contract rates and terms based on network need and adequacy
Glenridge HealthCare - Physician Contract Recruiter, Remote Position, Multiple Projects
August 2019 – May 2020 ( Due to the COVID 19 pandemic.)
Recruited and contracted hospitals, facilities and physicians for Cigna Health Spring Medicare campaign in PA, NJ and NY.
Negotiated contract rates based upon utilization and cost analysis.
Responsible for recruiting and contracting identified dental providers for the Liberty Dental Network. Negotiate fee schedules in accordance with predefined parameters.
Provide education and orientation regarding company guidelines, reimbursement structures and provider responsibilities.
Responsible for daily updates to the WebTracker system regarding redline contract negotiations.
Essential HealthCare Solutions- Network Development Consultant, Remote Position
October 2018- July 2019
Responsible for recruiting and contracting identified potential providers, hospitals and ancillary facilities to participate in the TriWest Civilian Provider Network (Patient Centered Community Care and Veterans Choice Programs)
Provide education and orientation regarding company guidelines, reimbursement structures and provider responsibilities.
Altitude Marketing, Lockport, NY
March 2016-September 2016
Full time commissioned position at a high-volume call center.
Customer Service responsibilities along with cross selling products offered by DISH Network satellite provider.
Anthem Inc/Tricare, (The Judge Group), Provider Network Manager II, Remote
March 2015-July 2015
Responsible for developing provider network through contract negotiations, relationship development and servicing.
Conducted analysis and prepared financial projections
Contracted and educated ancillary, medical grous and smaller institutional providers.
Served as primary communication link between provider and company.
Acted as a team resource for junior level consultants
Affinity Health Plan-Provider Relations Representative, Bronx, NY
February 2012-August 2013
Oriented providers regarding Affinity Health Plan operations
Conducted in-services and site visits with key hospital, physician and community-based providers to proactively identify any problems or concerns.
Assessed the network regularly to identify gaps in access
Visiting Nurse Service of New York-Contracting Associate
February 2008-August 2009
Recruited providers for VNS/Choice Medicare Network.
Negotiated contract terms in accordance with predefined parameters except in situations where special interest is recognized.
Education
West Virginia State College Institute
Business Administration, August 1988-May 1992
Software: Facets/Macess/MHS/SalesForce/Q-care/Cactus/Pegasus/Workbench/Microsoft Word/Excel/PowerPoint/Access/ Zoho-Peak 3
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