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building and managing
effective provider networks
is a foundation for managing cost and member satisfaction.
Contracting
Contract language development
(IPA/PHO/Physician/Hospital/Ancillary), network
development (expansion, startup) leadership and management,
service area expansion or product line development
including Medicare Advantage & HSD table preparation
Compensation
Payment systems and
methodologies, including Medicare payment methodologies,
rate analysis, analysis of costs based on historic claims
to identify cost opportunities, assessing and resolving
system issues with various payment methodologies
Credentialing
Credentialing program
assessment for NCQA review, downstream credentialing review
and program assessments
Training
Provider manuals and education tools for
commercial and government program products, commercial,
Medicare Advantage and Part D product
training
System Configuration
System configuration assessment and
review related to provider set up
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provider
network development and management 