Julia Hilliard
Wentzville,MO
Summary
Experienced leader with strong background in guiding teams, managing complex negotiations, and achieving strategic objectives. Proven ability to ensure regulatory compliance and streamline contract processes. Known for collaborative teamwork and delivering consistent results. Skills include contract drafting and risk management, with focus on adaptability and reliability.
Overview
19
19
years of professional experience
Work History
Contract Administrator, Sr.
Texas Children’s Hospital
12.2023 - Current
- Responsible for negotiating facility, ancillary and physician based contracts with health plans
- Work closely with internal teams to resolve authorization and claim issues
Senior Contracting Manager
United Healthcare
06.2023 - 02.2024
- Manage, create and negotiate a diverse portfolio of non standard prominent contracts, FQHC/RHC, Ancillary, Urgent Care, PHO, IPAs and hospitals for all lines of business to include Commercial, Medicaid, Medicare and Exchange products
- Collaborated closely with cross functional departments to include Finance, IT/Analytics, Market Operations, Data Analytics, Legal, Claims and Provider Services.
- Decreased contract negotiation timeframes with effective communication and collaboration strategies.
- Monitored contract performance against agreed-upon metrics, driving continuous improvement quality throughout the life of the contracts managed.
- Guide development of geographically competitive, broad access, stable networks that achieve objectives of provider specialties and geographic areas.
- Provide explanations and information to others on difficult issues
- Coach, provide feedback and guide others
- Reduced legal risks by ensuring compliance with company policies and industry regulations in all contracts.
- Optimized resource allocation by effectively managing multiple concurrent contract negotiations and administration tasks.
- Collaborated cross-functionally to identify contractual risks and develop mitigation strategies.
- Contributed to cost savings initiatives by renegotiating existing agreements for optimal financial outcomes.
- Led contract negotiations for high-value projects, securing advantageous terms for the company.
- Mentored junior staff members, contributing to improved team performance in contract administration tasks.
- Improved vendor relationships through timely and accurate contract administration.
- Monitored contracts' performance to detect non-compliance with terms and deficient returns and organize proactive resolutions.
- Onboarded and trained new staff to keep team efficient and prepare team members to effectively handle demands of simultaneous and large-scale contracts.
- Analyzed new laws and regulations to identify required changes and proactively adjust systems.
- Identified opportunities to streamline processes and improve office operations and efficiency.
- Interpreted contact terms and coordinated solutions to resolve disputes.
- Maintained primary relationship accountability for clients, overall servicing responsibility and client satisfaction to maximize profitability of client relationships.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
- Tracked contracts for management and issued regular tracking reports covering current status and upcoming milestones.
- Cultivated strong partnerships with internal stakeholders to align contracting activities with business objectives.
- Simplified complex contractual language to facilitate understanding among non-legal stakeholders.
- Increased efficiency by developing templates for standardizing common contractual clauses across various agreement types.
- Managed a diverse portfolio of contracts, ensuring timely renewals and minimal disruptions to business operations.
Senior Contracting Manager
SSM Health/Medica
07.2020 - 06.2023
- Responsible for developing and expanding the provider network through complex contract language and rate negotiations
- Develop and nurture ongoing provider relationships with providers to include health systems, hospitals, both large and small (including CAH) larger institutional providers and ancillary providers
- Contracts involve non-standard arrangements that require a moderate to high level of negotiation skills
- Responsible for working on cross-functional projects requiring collaboration with other key areas to include provider relations, sales and rate management team
- Additionally responsible for assisting in preparing financial projections and conducting analysis
- Train, educate and oversee other contract negotiators
- Volunteer on the contract language committee
- Expansion in key markets
Provider Network Manager, Sr.
Blue Cross of Idaho
10.2018 - 03.2020
- Responsibilities included developing the provider network through complex contract negotiations, relationship development, and servicing the assigned providers
- Negotiate non-standard arrangements and customized fee schedules
- Worked on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management
- Educate providers in managed care to include but not limited to value based and fee for service contracting
- Ensure that network composition includes an appropriate distribution of provider specialties
- Prepare financial projections and conduct analysis
- Create provider payment policies regarding reimbursement of claims
- Train, monitor and oversee contracting staff
- Serve as a communication link between professional providers and the company
- Collaborate with cross functioning teams such as legal, sales and provider operations
- Negotiate complex agreements to include rates and language
Contract Manager
Harvard Pilgrim Health Care
07.2015 - 09.2018
- Responsible for developing, negotiating and redlining complex contractual and financial arrangements with providers, e.g
- Hospitals, health systems, physicians and other non-physician providers based on per diem, DRG, percent of charge and RBRVS
- Manage and promote positive relationships with complex, highly leveraged providers
- Maintain ownership of assigned contracts, and familiarity with key provision and details of arrangements including volume, methodology, operational conditions, margins, membership and budget specifications
- Assessment of provider network and recommend provider specific strategies, goals and objectives
- Coordinate and communicate contractual terms to other departments, i.e
- Finance, Legal, and Sales
- Create and maintain budgets for assigned providers
- Serve as a key resource on Network Development complex and/or critical issues
- Negotiate hospital contractual and financial arrangements with providers
Network Development Executive
MultiPlan, Inc.
06.2011 - 05.2015
- Responsible for negotiating and executing health system, facility, ancillary and large group contracts to support penetration and discount objectives relative to competitive market tends and client expectations through comprehensive, aggressive execution of region contracting goals
- Additionally, responsible for fostering and maintaining superior provider relationships
- Respond to provider questions and issues relating to claims, contract interpretation, allowable amounts, and other issues that are escalated for resolution
- Work as a liaison between providers and other departments such as the Sales and Account Management, Provider Data Management, Credentialing, Rate Management, Customer Service and other operational departments
- Maintain and exceed contracting consistent with established regional goals
- Mentor and coach less experienced contractors
- Manage complex provider contract language and rate negotiations
- Forge strategic partnerships with high profile providers
Contract Specialist
Coventry Healthcare
05.2006 - 05.2011
- Increased network for managed care contracting with large groups of physicians, ancillary providers and hospitals for all contracts pertaining to fully insured, Health Plan, PPO, corporate accounts, lease networks and workers' compensation
- Recruited and contracted with large groups, hospitals and health systems who met established selection criteria to assure adequate geographic and specialty coverage
- Also responsible for provider issues to include, but not limited to, contract language clarification, rate reimbursement, inquiry of claims, and explanation of benefits
- Complex contract negotiations with groups and hospitals in multiple states
- Responsible for the development and monitoring of provider contracts
Skills
- Value Based Contracting
- Redlining
- Budget Planning
- Conflict Resolution
- Managed Care
- ACO
- Revenue Cycle
- Critical Thinking
- Contract terms negotiation
- Relationships and rapport
- Contract drafting
- Interpersonal and written communication
- Contract reviews and edits
- Contract performance monitoring
- Critical thinking
- Performance evaluations
- Relationship building
- Staff management
- Policy and procedure modification
- Strategic planning
- Staff training
Accomplishments
- Supervised team of [Number] staff members.
- Documented and resolved [Issue] which led to [Results].
- Achieved [Result] by introducing [Software] for [Type] tasks.
- Achieved [Result] by completing [Task] with accuracy and efficiency.
Languages
English
Timeline
Contract Administrator, Sr.
Texas Children’s Hospital
12.2023 - Current
Senior Contracting Manager
United Healthcare
06.2023 - 02.2024
Senior Contracting Manager
SSM Health/Medica
07.2020 - 06.2023
Provider Network Manager, Sr.
Blue Cross of Idaho
10.2018 - 03.2020
Contract Manager
Harvard Pilgrim Health Care
07.2015 - 09.2018
Network Development Executive
MultiPlan, Inc.
06.2011 - 05.2015
Contract Specialist
Coventry Healthcare
05.2006 - 05.2011
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