TIMOTHY B. BROWN, Sr.

Maple Heights, Ohio

Home: 216-***-**** Mobile: 216-***-**** E-mail: adva7b@r.postjobfree.com

Network Development Managed Care Managed Care Negotiations Ancillary Contracting Revenue Management Cycle Project Management

Seasoned managed care professional with a record of accomplishment in delivering unprecedented leadership and relationship building while negotiating favorable rates and contract language in Hospital, Physicians (PCP and Specialist), Vision and Dental providers, Ambulatory Surgery, Home Health, Skilled Nursing, Mobile x-ray, Home Infusion, Durable Medical Equipment contracts from the provider and payer position. Known for offering various methods of reimbursement including pay for performance and their appropriate applications; Formulate long and meaningful relationships with external and internal stakeholders.

Experience

CareSource Management, Inc.

Health Partner Contracting Manager

Ohio Market Contracting 2019 - Present

Provide contract negotiation of major hospital systems, IPA’s and PHO’s, market analysis and relationship building in new target markets. Managing team to gain a greater understanding of contract management; in addition to, insuring that CareSource meets adequacy standards of the presiding regulatory bodies. Working with Hospital partners to reconfigure value-based relationships.

CareSource Management, Inc.

Network Development Manager

Corporate Network Development 2015 - 2017

Provide contract negotiation of major hospital systems, IPA’s and PHO’s, market analysis and relationship building in new target markets. Managing team to gain a greater understanding of contract management; in addition to, insuring that CareSource meets adequacy standards of the presiding regulatory bodies.

Development of Sharepoint contact management tool to assist Sr. Management manage the progress of a new network build.

Assisted in Provider Relations functions to educate new Georgia health partners of CareSource and its various systems and links to ensure the health partner has access utilization review, claims payments, preauthorization and general corporate information

Five Star Healthcare Consultants

Independent Consultant

Contracting and Network Development 1997-2019

Provide contracting market analysis, provider network development and financial data services to a wide range of healthcare companies with the intent of growing their business through various reimbursement methodologies, and greater understanding of contract management; in addition to, insuring the client remains in compliance with CMS and NCQA along with other regulatory bodies.

Integral in the negotiations of provider reimbursement, on-site visits with vendors, cost analysis, trend analysis and monitoring of provider network. Successfully completed a variety of projects: provider negotiations and contracting; cost report analysis; joint ventures; development of contract efficiency workflow systems; development and implementation of statewide networks.

Monitored the provider network expansion strategy and developed internal processes for contract management.

Primary Health System of Ohio

Corporate Director Medical Contract Management /Director of PHO Operations 1999-2001

As a full-time consultant via Five Star HCC, managed all contracting and analysis with health insurance companies for both the Hospital system and the Physician Hospital Organization (PHO); in addition to, monitoring physician network access in managed care organizations and internal physician credentialing process.

Successfully completed a variety of projects: added new PPO and HMO relationships; worked with physician billing collection issues, and development of contract efficiency workflow systems.

Established, organized and edited physician newsletter. As well as authoring many articles, soliciting articles on various health care related topics, and gaining financial support.

Blue Cross & Blue Shield of Ohio

Ancillary Network Administrator

Provider Contracting & Network Development 1990-1997

Developed methodology and managing contracting with ancillary providers and smaller hospitals in Ohio for traditional Blue Cross, Super Blue HMO, CareWorks and specialty programs.

Duties included negotiation with providers, on-site visits with vendors, cost analysis using cost reports to determine reimbursement rates, trend analysis and monitoring of provider and customer satisfaction. Also, negotiated small market hospitals reimbursement.

Accomplishments include significant cost savings and quality of care with Skilled Nursing Facilities and Ambulatory Surgery Center by renegotiating contracts and building strong relationships.

Education and Licenses

Public Administration - Cleveland State University, Cleveland, Ohio

Bachelor of Arts - Cleveland State University, Cleveland, Ohio

Certificate in Project Management – Cornell University eCornell, Ithaca, NY

Technical Applications

Microsoft Windows, MS Office, Lotus Notes,

Salesforce Contact Management Software, Revenue Cycle Management, Oracle Contract Management and National Database

Professional Affiliations

Project Management Institute (PMI)

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