Hilary Greason
Summary
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
12
12
years of professional experience
Work History
Regional Vice President Value Based Provider Partnerships
eHealth, Inc.
03.2020 - Current
- Company Overview: eHealth, Inc
- Provides health insurance exchange services to individuals, families, and small businesses with an emphasis on Medicare Beneficiaries and Medicare Advantage and ACA plans
- Its e-commerce platforms organize and present health insurance information that enable individuals, families, and small businesses to research, compare, and purchase a range of health insurance plans
- Responsible for engaging Health Systems, Provider Groups and Management Services Organizations in eHealth Strategic Partnerships aimed at improving Medicare Advantage enrollments among patient populations to diversify revenue and increase engagement in Value Based Contracting arrangements
- Achievements include:
- Organization SME on Value Based Contracting as it pertains to Medicare Advantage growth strategies and healthcare partnerships
- New partnerships contracted include The Cleveland Clinic, Agilon Health, Optum Care, UCLA Health, Cedars Sinai, Providence, Instacart
- Assisted product design of digital solutions and API implementations to improve patient journey and increase Medicare Advantage enrollments to align with Value Based Contracting objectives
- New lead generation through cold calling, outreach to professional network and attending healthcare industry events
- Assisted with account implementations in collaboration with Partner Success Management team
- With peers developed forecasting methodology to determine potential growth of new and existing partners
- Managed financial performance by setting budgets, monitoring expenses, and identifying areas for improvement.
- Negotiated strategic partnerships with vendors to secure favorable terms and pricing for products or services.
- Strengthened relationships with key clients by providing exceptional customer service and support.
- Expanded the company's presence in new territories, establishing valuable partnerships and increasing market penetration.
- . Facilitated organizational change management efforts as needed to adapt quickly to shifting market dynamics or customer preferences.
- Delivered regular progress reports to senior leadership, providing clear metrics on regional performance against company goals.
- Mentored direct reports, fostering a positive work environment that encouraged professional growth and development.
- Facilitated cross-functional team collaboration to tackle complex challenges, resulting in innovative solutions that drove competitive advantage.
- Negotiated favorable terms in high-stake contracts, safeguarding company interests while fostering long-term relationships with key clients and suppliers.
VP Network Development and Contracting
Centene Corporation
02.2019 - 10.2019
- Company Overview: Centene operates in 23 states and 3 international markets with 53,600 employees and more than 15 million Managed Care Members
- Products are Medicaid, Medicare and Commercial Health Insurance plans
- As the state VP for these two Health Plans was responsible for Contracting, Provider Relations, Contract Configuration, Risk Adjustment, Provider Data Management and Credentialing
- Supervised 8 direct reports and a total staff of 62
- Achievements included:
- Contracted with a network of providers throughout the state to meet the care needs of members, creating project plans and timelines to meet critical regulatory deadlines
- Key writer in Request for Application to Oregon Health Authority Medicaid contract resulting in award of three additional Oregon counties in the Portland Metro area
- Built a new Medicaid Network in 90 days to meet Oregon Health Authority Network Adequacy requirements
- Improved Provider Relations through key provider visits with C-Suite executives to discuss claims, contracting concerns, and collaboration in the Value Based and Quality contract agreements
- Initiated a mobile team of Provider Relations experts to go onsite with Providers and solve issues in real time
- Tracked and trended the contract implementation of configuration teams loading new and updated contracts; improved accuracy and timeliness of contract uploads through testing and accurate claims payments
- Reduced Provider claims errors by 30% that were attributed to configuration errors
- Risk Adjustment/Risk Corridors included negotiating with vendors to obtain chart data and educating Providers on appropriate documentation and care management of members
- Turn-around times for credentialing Providers and adding, termination or changing provider demographic data were reduced from 45 days to 30 days
- Demonstrated proficient leadership skills to motivate employees and build competent teams.
- Collaborated with senior management to develop strategic initiatives and long term goals.
- Negotiated high-value contracts that maximized profitability while mitigating risks for the organization.
- Managed financial planning and budgeting processes, ensuring fiscal responsibility and maximizing return on investments.
AVP, Network Management
FirstCare Health Plans
01.2016 - 01.2019
- Company Overview: A Managed Care organization with more than 185,000 commercial and Medicaid members in 145 counties in the state of Texas
- Provided Executive Leadership to four key operational teams for both government programs and commercial lines of business for the health plan in three offices in Central and West Texas
- Managed projects efficiently, ensuring timely delivery and high-quality results.
- Responsible for the following departments:
- Streamlined communication channels between departments, facilitating better collaboration on projects across the organization.
- Contracting staff (4) activities encompassed strategic prospecting to maintain networks that meet and exceed adequacy standards as set forth by Federal and State regulatory agencies
- Maintained compliance with industry regulations by implementing risk mitigation measures and maintaining accurate documentation.
- Reviewed Contracts to ensure reimbursement rates were negotiated to meet financially sustainable models that foster good fiscal stewardship of publicly funded programs and support cost containment efforts
- Provider Relations staff (10) located throughout the state of Texas servicing contracted providers through education regarding program provider requirements, changes to regulatory processes and requirements
- Also assisted with provider recruitment to maintain a robust network that is compliant with regulatory agency Network Adequacy requirements
- Credentialing and Provider Data Integrity Director and combined staff (11) to improve processes and maintain minimum performance standards for both production areas
- Credentialing team credentialed provider groups and practitioners in accordance with regulations
- Monitored Primary Source Verifications, Credentialing Committee, and Peer Review
- Ensured timeliness of process for all files and submission of quarterly reports to Federal and State regulatory agencies
- Provider Data Integrity was accomplished with a Manager and 5 Database Specialists who maintained contract details and provider / practitioner demographics as well as assisted with contract configuration requirements
- Supported Vistar Software implementation providing software architecture support to Information Technology teams
- Supported Provider Data Integrity clean-up through new process implementations that included grassroots provider outreach, use of LexisNexis data validation files, and the employment of vendor to conduct provider calls to verify demographic data
- Migrated Contracting process from manual to a digital environment that improved turn-around times, reduced errors, standardized contract templates and created a digital repository that could be queried for contract data
Director, Network Development
Banner Health – University of Arizona Health Plans
01.2014 - 01.2016
- Company Overview: Community Health System organization with 300K members generating $13.4B in annual income with $7.16B in assets; provided services in 7 states in the Western U.S
- Prospected Medicare and Medicaid registered provider groups and practitioners needed to develop a robust network to better serve plan members
- Implemented long term network development regarding new lines of business
- Responsible for the following departments:
- Contracting Contract Manager and 4 staff members within Contracting operation; negotiated contracts regarding rates of reimbursement for medical services
- Provider Relations Manager and 10 team members maintaining accounts initiated by Contracting team
- Communicated changes in claims requirements, regulations, policy, and procedures
- Assisted in planning annual education forums ensuring all mandatory education from Federal and State regulators was disseminated by Provider Relations
- Served as public spokesperson visiting practice groups and practitioners
- Credentialing Manager and 4 Credentialing Specialists focusing on credentialing provider groups and practitioners in accordance with regulations
- Monitored Primary Source Verifications, Credentialing Committee, and Peer Review
- Ensured timeliness of process for all files and submission of quarterly reports to Federal and State regulatory agencies
- Network Database Operations Manager and 4 Database Specialists responsible for Provide Data Integrity
- Led implementation of McKesson Provider and Contract Manager Software that served as data warehouse
- Allowed digital contract negotiations, tracking, trend analysis, and contract cataloging
- Created contract templates in collaboration with Legal Counsel that met all Federal and State regulatory requirements
- Evaluated historic contracts to verify justified rate of reimbursement
- Saved $600K within first month of review initiative by rewriting contracts that were paying exorbitant rates for services
- Built Arizona Long Term Care Services network in accordance with Arizona Health Care Cost Containment System requirements of providers in preparation for 2017 bid
- Bid won
- Directed turnaround of Credentialing operation 6 months behind in processing applications and out of compliance with state credentialing policies
- Implemented process improvements, skill evaluations, and workflows
- Secured full compliance within 7 months
- Reduced processing time by 66% in 7 months and increased overall files received for processing 43%
- Restructured workflows for Network Database operation with 5,000+ Service Requests (more than 50% older than 12 months)
- Identified manual processes that slowed production times and engaged IT to conduct full system evaluation
- Reduced SRs in queue to 500 or fewer with less than 19% of those requests over 45 days
- Slashed interest paid on overdue claims by $385K in 2016
- Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
- Facilitated cross-functional collaboration for improved decision-making processes within the organization.
- Improved project efficiency with strategic planning, resource allocation, and time management practices.
Market Manager, Health System Integration
Banner Core Centers for Orthopedics
01.2013 - 01.2014
- Served as Market Manager for Center of Orthopedic Research and Education surgery centers located in 5 Banner Health hospitals across Phoenix
- Managed marketing, clinical, and quality tracking
- Monitored value-based purchasing and bundled payment arrangements including risk sharing model tied to patient outcomes
- Created Bundled Payment Methodologies for Joint Replacement with payer organizations
- Key player in creating marketing materials including brochures, websites, patient experience books, educational videos, community event sponsorship, Web analytics, media placement, and purchasing
- Increased patient volumes via marketing to community and referring physicians
- Established relationships with insurance representatives
- Produced patient experience 'Passport,' patient education video, BannerCoreCenter.com website, and sponsorships of 45+ community events resulting in 13% YOY increase in patient volumes
Education
MS - Management Information Systems
University of Phoenix
Tucson, AZBS - Business Management & Marketing
University of Phoenix
Tucson, AZSkills
- Leadership
- Mentorship
- Provider Network Development
- Information Systems
- Contract Negotiations
- Medicare & Medicaid
- Provider Relations
- Process Improvement
- Strategic Planning
- Credentialing
- Data Management
- Regulatory Compliance
- Value Based Contracts and Alternative Payment Methodologies
- Strategic Partnership
- Business Development/Sales
- Financial management
- Project management
- Customer relationship management
- Cross-functional collaboration
Timeline
Regional Vice President Value Based Provider Partnerships
eHealth, Inc.
03.2020 - Current
VP Network Development and Contracting
Centene Corporation
02.2019 - 10.2019
AVP, Network Management
FirstCare Health Plans
01.2016 - 01.2019
Director, Network Development
Banner Health – University of Arizona Health Plans
01.2014 - 01.2016
Market Manager, Health System Integration
Banner Core Centers for Orthopedics
01.2013 - 01.2014
BS - Business Management & Marketing
University of Phoenix
MS - Management Information Systems
University of Phoenix
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