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Chris_Resume 071215

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Chris_Resume 071215

  1. 1. Chris A. Reed 17023 Puntledge Drive Westfield, IN 46062 (419) 410-9202 MANAGER / COST CONTAINMENT AND CLAIMS AUDIT DEPARTMENT Cost Containment Manager of Medical Concierge Service, ensuring the Medical Concierge Service provides information to patients in need of non-emergency medical procedures that will help them decide on a facility that provides high quality care in the most cost-effective setting. The procedure can be in-patient or out-patient, and as simple as an MRI or as complex as a Transplant. We have comprehensive data indicating that different facilities can perform identical procedures at substantially different costs and levels of quality. My goal is to make sure that quality of care is the primary consideration, while at the same time provide meaningful, easy to understand information relative to the cost of the procedure at competing facilities. I work with a Team that pulls Quality Measurements from public sources run by government agencies. It is composite measure of four components of hospital value: quality of service, affordability of services, efficiency of service, and patient satisfaction with service. My experience has helped lead our Team to help employees save money, Health Plans save money. Money saved can surpass PPO savings and significant return of investment for the Health Plan. Prior job, helped build Healthcare Network (Supermed Network) from ground up for Indiana. Extensive experience negotiating contracts and managing provider compensation / reimbursement. Proven network management methodologies, best practices, and dedicated customer relations skills, earning a solid reputation for the highest levels of contract performance, quality vigilance, consistency, reliability, support, and clarity across all functional lines. Core competencies include: • Planning / Activity Coordination • Strategic Planning / Implementation • Problem Resolution • Process Improvement • Customer Service Optimization • Mission / Vision Fulfillment • Mentor / Coach / Train • Project Management • Policy / Procedure Development and Delivery • Contract Negotiations and Execution • Cost Containment PROFESSIONAL EXPERIENCE International Medical Group - Akeso Care Management, Indianapolis, IN January 2015 – Present Medical Concierge/Claims Audit Manager – Manage four Medical Concierge Reps. And two claim auditors. ACM is an accredited international health care management company specializing in the complete spectrum of domestic and medical management service. Provide information to patients in need of non-emergency medical procedures that will help them decide on a facility that provides high quality care in the most effective setting. Our goal is cost containment for the member and the employer. IU Health Plans, Indianapolis, IN September 2014 – December 2014
  2. 2. Chris Reed Page 2 Senior Consultant – Network Management Provider Relations, Network Management expansion efforts, Network Management Training, Network Management Policies and Procedures development. Managing Hospital and Ancillary Contracting. Medical Mutual, Cleveland, OH 1997 - 2014 Medical Mutual has been a trusted health insurer for 80 years as the oldest and largest health insurance company headquartered in the state of Ohio. Provider Contracting Manager, Network Management 2012 - 2014 Facilitated the management of Medical Mutual’s Indiana provider network. Recommended the strategic direction for managed care networks. Oversaw Medical Mutual’s relationships and contract negotiations with physicians and hospital providers throughout the state of Indiana. • Managed the Company’s provider recruiting and contract efforts to help build and maintain a comprehensive and cost-effective provider network for the Company and its customers in Indiana. • Oversaw six employees, four Provider Contracting Representatives and two Provider Coordinators. • Facilitated all network management activities. Provided direction and recruiting and contracting efforts to network management team. • Implemented all policies related to network development, including prioritizing counties for recruitment, regular data reporting on network composition, and communication to sales and customer relations of network recruiting plans and network improvements. • Acted as a focal point and interacted with various areas that impacted providers, including Provider Information Management, Provider Reimbursement, Provider Communications, Operations, Network Performance, Care Management and Legal to ensure proper integration and support of key objectives across all functional lines as well as external entities. • Trained and developed contracting and coordinator team to optimize team and individual effectiveness. Provider Contracting Representative, Fayette, MO 2009 - 2012 Recruited and negotiated contracts with medical providers (physician, hospital and ancillary) to build Proprietary Healthcare Network in the state of Indiana from the ground up. Provided education and training to medical offices and their staff. • Oversaw 24 counties in Southwest part of Indiana and 4 counties in Southeast Indiana. • Managed large provider hospital organization groups in Southwest Indiana. • Managed, promoted, guided and monitored, as well as serviced and educated providers, Institutions and Network Communities to establish a business relationship. • Participated in building team of an Indiana Proprietary Network from the ground up. Provider Contracting Representative, Toledo, OH 2007 - 2009 Developed, managed and provided services to Institution and Network Communities in order to establish business relationship. Managed counties in Northwest Ohio and built Indiana for Proprietary Network. • Oversaw 11 counties in Northwest, Ohio, plus two Physician Hospital Organization groups. • Built up Indiana Network. • Oversaw 7 counties in first phase of Indiana, while continuing to keep territory in Ohio up to date. Provider Contracting Coordinator, Toledo, OH 2005 - 2007 Assisted Contractors and Management by maintaining familiarity with each account and their designated representatives; understood provider contracts, and field calls / concerns that occurred. In addition, prioritized and researched problems affecting providers and maintained up-to-date contract and contract management files and documentation. • Reported to 4 Provider Contracting Representatives.
  3. 3. Chris Reed Page 3 • Assisted in various duties, including maintenance of providers, credentialing, and rate maintenance. • Built professional and hospital provider workbooks. • Provided ongoing assistance to representatives. Claims / Customer Service, Toledo, OH 1997 - 2005 Worked in a high-volume, fast paced operations department that required a specific quota to meet proper daily processing of medical claims. • Spoke with members and providers, primarily servicing Ohio Retirement Service members. • Verified benefits, researched claims, and adjusted claims when necessary. PROFESSIONAL RECOGNITIONS / ASSOCIATIONS • Shining Star Award presented by Kevin Lauterjung, Vice President, and Manager Valerie DiMasso for overseeing Ohio territory while taking on 7 additional counties in Indiana to recruit and build Phase I of Indiana Proprietary network. • Member of Executive Women in Health Care. EDUCATION Bachelor of Arts (BA) in Business Management (partial completion) Arizona Western College, Yuma, AZ TECHNICAL SKILLS Excel, PowerPoint, Access, Word, Kronos, Microsoft Outlook, HRAdvantage, Cisco VPN