Anthony Mungen

Buffalo, NY *****

716-***-****©

ad3e0p@r.postjobfree.com

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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