Matthew Mercer
Kansas City,MO
Summary
Achieved improved quality of life for service recipients by fostering a culture of respect and support. Enhanced service delivery through effective network building and provider account management. Delivered significant improvements in health outcomes while reducing costs for the organization.
Overview
14
14
years of professional experience
Work History
Manager- Specialized Provider Contracts
Molina Healthcare
Kansas City, MO
10.2024 - Current
- Independently manage complex contract negotiations focused on value with large ACO, PHO, and IPAs in Nebraska.
- Immediately made a positive impact by signing and delivery of contracts with two major organizations in Nebraska utilizing full capitated risk models within six months of employment.
- Manage and mentor a small team of contract negotiators to enhance the provider network in Nebraska.
- Conduct comprehensive evaluations and strategic planning for network adequacy.
- Facilitate negotiations for high-cost treatment services to optimize patient care options.
- Facilitate identification and planning of KPI and SAI cost-saving initiatives.
- Oversee account management for large health systems, emphasizing relationship building and maintenance for accounts representing over a total of $75 million in business impact.
Manager- Contract Negotiations
Aetna Better Health
Kansas City, MO
09.2022 - 10.2024
- Facilitated complex contract negotiations with ancillary LTSS hospitals and primary care providers across Kansas, Illinois, and Michigan.
- Assisted in negotiating single case agreements with out-of-network providers and out-of-state providers. Supported the coordination of letters of agreement to facilitate provider partnerships. Collaborated with teams to streamline negotiation processes for improved outcomes.
- Spearheaded development of value-based models in collaboration with state government providers and internal stakeholders.
- Oversaw LTSS contracting for HCBS initiatives, ensuring effective cost allocation for underfunded service pools.
- Formulated value-based contract language for home and community-based services and specialist providers, enhancing collaboration beyond traditional value-based care arrangements.
- Assisted in developing strategies and managing program success. Supported project development and coordinated project management efforts with team and senior leadership.
- Assisted teams in setting collaboration goals to enhance project outcomes. Supported educational initiatives for career development and team evaluation. Facilitated regular feedback sessions to improve team performance.
- Facilitated development of special collaboration agreements with participating providers for state RFP proposal submission.
- Assisted in planning and monitoring network build projects. Supported writing and evaluation of state RFPs. Collaborated with teams to ensure project objectives were met.
- Managed and mentored a team of four contract negotiators across the central Region representing three MCO contracts.
Senior Contract Negotiator
Centene- Home State Health
11.2020 - 10.2022
- Facilitated contract negotiations with diverse provider types for services within Medicaid Managed Care plan, Commercial Marketplace plans and Medicare Advantage plans.
- Facilitated joint operation meetings with providers to address contract compliance and regulatory changes.
- Oversaw cost allocation processes for newly established special projects and value-added services targeting managed Medicaid and DSNP populations.
- Oversaw contracting and provider education initiatives for sole-source foster care award and newly established psychiatric services.
- Spearheaded value-based contracting initiative for managed Medicaid providers in Missouri, transitioning agreements from fee-for-service to shared savings and alternative payment models.
- Crafted and refined unique contract language for provider and vendor agreements.
- Evaluated liability risks associated with financial plans and compliance requirements.
- Reported contracting progress to Vice President of Networking and National Vice President of Networking for Centene Corporate.
- Spearheaded development of value-based language and programs through rigorous test and retest change management processes.
- Conducted SOC audits to mitigate risks associated with third-party organizations managing business operations under state CMS contracts.
Provider Performance Specialist
Centene- Home State Health
07.2019 - 10.2020
- Facilitated meetings with providers to assess quality performance against contractual and regulatory compliance standards.
- Compiled comprehensive reports for provider evaluation and quality enhancement.
- Directed value-based provider performance reporting and facilitated joint operations meetings.
- Spearheaded HEDIS and risk adjustment reporting initiatives, collaborating with internal teams and external stakeholders.
- Facilitated communication with providers to enhance quality improvement initiatives and ensure compliance with state and federal policies.
Provider Relations Liaison (Contract Specialist)
Missouri Dept. of Mental Health
Kansas City, MO
11.2016 - 07.2019
- Oversaw contract application processes for organizations aiming to provide services to individuals with developmental disabilities.
- Evaluated contract applicant qualifications in accordance with Department of Mental Health and Developmental Disabilities guidelines.
- Delivered technical support to potential and current contracted providers.
- Oversaw management of 30+ business accounts for organizations contracted with the Division of Developmental Disabilities, ensuring compliance with HCBS waiver allocations.
- Facilitated ongoing training sessions for affiliated organizations on federal and state mandated changes.
- Executed audits and designed training programs for contracted providers to ensure compliance with Medicaid home and community-based services regulations.
- Spearheaded development and implementation of quality improvement plans addressing compliance issues for providers.
- Oversaw HIPAA compliance initiatives to guarantee proper retention and utilization of PHI within Kansas City regional office as the HIPAA Compliance Officer.
Assessment Specialist II
Missouri Dept. of Mental Health
Kansas City, MO
05.2015 - 10.2016
- Administration of several assessment protocols including- Support Intensity Scale, Adaptive Behavioral Evaluation Scale, Missouri Critical Adaptive Behavioral Inventory.
- Eligibility determinations for services through Dept. of Mental Health/Developmental Disability Division.
- Collaborated with providers and inner departmental partners to review and assess patient health information for eligibility determinations.
- Created and implemented trainings on assessment protocols for Technical Case Management agencies that were used statewide for agencies contracted with the Dept. of Mental Health/Developmental Disability Division.
- Designated SharePoint subject matter expert wherein I was given edit access to SharePoint sites to maintain and improve SharePoint operations
Clinical Caseworker
Center for Behavioral Medicine (Department of Mental Health)
Kansas City, MO
02.2012 - 04.2016
- Supported clients through advocacy and financial management tasks. Assisted in medication management and teaching essential skills. Coordinated care by maintaining clinical charting and reports.
- Supervised and directed 8 direct care workers in a residential facility.
- Collaborated with physicians and hospital administration to facilitate successful patient placement and transition.
- Formulated person-centered plans to define daily needs of individuals in care.
Education
Masters of Integrated Health Management - undefined
Western Governors University
01-2019
Bachelors of Arts Degree - Psychology, Classical Studies (Latin)
University of Missouri-Kansas City
01-2012
Skills
Facilitated customer satisfaction through effective communication and problem-solving strategies
Facilitated team leadership initiatives to drive project success and achieve organizational goals
Implemented effective time management strategies to streamline workflow and meet deadlines
Executed informed decision-making to drive project success and align with business objectives
Championed effective communication strategies to enhance team collaboration and project outcomes Led initiatives to improve written documentation standards across departments Fostered an environment of open dialogue to address stakeholder concerns promptly
Applied strategic thinking to identify and address multifaceted issues, enhancing operational efficiency
Oversaw training initiatives to enhance staff capabilities and performance Developed comprehensive training programs aligned with organizational goals Mentored team members to foster professional growth and development
Facilitated effective task delegation to enhance project workflow and accountability
Developed strategic partnerships to support organizational objectives and foster teamwork
Facilitated strategic planning sessions to define long-term objectives and enhance operational efficiency
Coordinated efforts among diverse teams to drive successful initiatives
Implemented CRM strategies to strengthen customer engagement and retention
Implemented performance management strategies to align employee goals with organizational objectives
Mediated disputes among team members to foster a positive work environment
Managed budget control initiatives to optimize resource allocation and minimize costs
Cultivated strategic partnerships and identified new business opportunities to enhance revenue streams
Administered contract management activities to support organizational objectives and maintain vendor relationships
Developed and maintained partnerships to support organizational objectives and expand market reach
Timeline
Manager- Specialized Provider Contracts
Molina Healthcare
10.2024 - Current
Manager- Contract Negotiations
Aetna Better Health
09.2022 - 10.2024
Senior Contract Negotiator
Centene- Home State Health
11.2020 - 10.2022
Provider Performance Specialist
Centene- Home State Health
07.2019 - 10.2020
Provider Relations Liaison (Contract Specialist)
Missouri Dept. of Mental Health
11.2016 - 07.2019
Assessment Specialist II
Missouri Dept. of Mental Health
05.2015 - 10.2016
Clinical Caseworker
Center for Behavioral Medicine (Department of Mental Health)
02.2012 - 04.2016
Masters of Integrated Health Management - undefined
Western Governors University
Bachelors of Arts Degree - Psychology, Classical Studies (Latin)
University of Missouri-Kansas City