Brian Murray
Waynesboro,GA
Summary
Dynamic professional with extensive experience at Centene Corporation, excelling in contract negotiation and network management. Proven track record in provider recruitment and data analysis, driving significant improvements in network adequacy. Adept at fostering relationships and achieving strategic goals, ensuring optimal provider performance and satisfaction.
Overview
35
35
years of professional experience
Work History
Sr. Network Management Representative/ Contract Negotiator II
Centene Corporation/ WellCare
GA
12.2014 - 08.2025
- Responsible for all Network Adequacy/ Geo Access activities including reporting, prospecting and recruitment.
- Services, contracts and negotiates with providers for all product lines in assigned markets.
- Manages network by developing and maintaining physician relationships to drive results.
- Identifies strategies to achieve Medical Expense Initiatives (MEI).
- Analyzes network gaps and identifies providers to contract.
- Reviews and amends provider's contracts when necessary.
- Assesses performance and contract rates of providers to ensure our network is cost efficient.
- Strategies for membership growth and retention.
Sr. Provider Relations Representative
WellCare
Augusta, GA
04.2013 - 12.2014
- Manages physician network by developing and maintaining a geographic area.
- Responsible for developing and maintaining excellent relationships with both external and internal customer to maximize provider experience.
- Completes provider orientation sessions and training on all aspects of the program.
- Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
- Ensures that revenue is maximized on the Service Fund team to coordinate RAPS chart chases to ensure that charts are coded to the highest level appropriate with correct coding.
- Exceeds goals to ensure a consistent and strong relationship with provider offices.
- Provides training, mentoring and guidance to newly hired representatives.
- Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, and other analytics available to improve quality and maintain region.
Benefit Consultant
WellCare
Augusta, GA
08.2011 - 04.2013
- Generate referrals utilizing sources other than support by corporate.
- Prospect for leads and convert to appointments.
- Utilize territorial model philosophy to maximize marketing efforts in attaining new enrollments.
- Maintain disenrollment rate that is deemed acceptable from the company.
- Convert appointments into enrollments.
- Event planning.
- Achieve corporate enrollment goals.
- Ability to communicate effectively in person and by phone.
- Strictly adhere to all CMS and WellCare Marketing MIPPA regulations.
Sr. Provider Relations Representative
WellCare Health Plans
Augusta, GA
04.2006 - 08.2011
- Manages physician network by developing and maintaining a geographic area.
- Responsible for developing and maintaining excellent relationships with both external and internal customer to maximize provider experience.
- Completes provider orientation sessions and training on all aspects of the program.
- Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
- Exceeds goals to ensure a consistent and strong relationship with provider offices.
- Provides training, mentoring and guidance to newly hired representatives.
- Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, and other analytics available to improve quality and maintain region.
Regional (Project) Manager
MAXIMUS INC
Augusta, GA
09.1997 - 10.2005
- Managed the Georgia Child Support Enforcement Project serving 14 counties in the Augusta, Valdosta and Columbus areas.
- Responsible for operations, with overall management of 3 offices, 59 project employees, including 3 Operations Managers.
- Full oversight for all aspects of project management from client management and contract negotiation, and fiscal controls including budgeting and forecasting.
- Oversaw all day to day operations, with responsibility for QA, productivity, compliance standards, and staff management and development.
- Accountable for timely project deliverables, quality of services, as well as ensuring compliance with federal program and contractual requirements.
- Researched, evaluated and applied measurement metrics to productivity, accuracy, process enhancement and team building programs in order to meet goals.
- Cultivated key relationships with internal/external customers including judges, clerks, state administrators and community agencies to facilitate operational and program excellence.
Office Manager
DEPARTMENT OF HUMAN RESOURCES
Augusta, GA
05.1990 - 09.1997
- Responsible for the Child Support Enforcement team of 59 employees and 5 supervisors including a payment center and for the Augusta Judicial Circuit Court.
- Managed the service staff responsible for determining eligibility for child and medical support services, as well as working with legal services on child support actions.
- Accountable for human resource management from hiring and training through performance evaluation and promotions.
- Nurtured key relationships at all levels for the utmost in customer service and satisfaction.
- Demonstrated superior communication and management skills in evaluating, addressing and resolving operational issues.
Education
Bachelor of Arts - Economics
University of Georgia
Athens, GA06.1985
Skills
- Contract negotiation
- Network management
- Provider recruitment
- Data analysis
- Geographic access reporting
References
Available upon request
Timeline
Sr. Network Management Representative/ Contract Negotiator II
Centene Corporation/ WellCare
12.2014 - 08.2025
Sr. Provider Relations Representative
WellCare
04.2013 - 12.2014
Benefit Consultant
WellCare
08.2011 - 04.2013
Sr. Provider Relations Representative
WellCare Health Plans
04.2006 - 08.2011
Regional (Project) Manager
MAXIMUS INC
09.1997 - 10.2005
Office Manager
DEPARTMENT OF HUMAN RESOURCES
05.1990 - 09.1997
Bachelor of Arts - Economics
University of Georgia
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