SAMUEL BARNES
Nashville,TN
Summary
Strategic C-Suite healthcare executive with 10+ years of experience in managed care negotiations, payor relations, operations and revenue cycle management. Subject matter expert in all ends of payer strategy, contract negotiations, physician and facility reimbursement, CMS / Payor Regulatory requirements with an emphasis in risk mitigation and revenue growth.
Overview
5
5
years of professional experience
Work History
Chief Managed Care Officer
VIVO Infusion
11.2021 - Current
- Recruited by InTandem Capital Partners as a senior strategic leader to build out the corporate payer strategy for VIVO Infusion, report directly to CEO
- Managed, trained and lead a team of 26 employees responsible for payer contracting, credentialing, enrollment, payer operations, bad debt management, litigation and dispute resolutions
- Responsible for managing and negotiating a payer portfolio of over $750M in commercial and managed care revenue
- Responsible for the payer strategy and management of payer performance across 20 states, 100+ infusion clinics and over 220 clinical providers.
- Leveraged my relationships with health plan executives to bring VIVO Infusion and its affiliates, both de novo and acquisition, in-network with all of the national and regional payers
- Negotiated significant reimbursement increases with all major payers including Anthem, UHC, Cigna and Aetna that resulted in an increased EBITDA contribution margin of $19.5M over a 3 year period.
- Leveraged both market share & cost effective services through payer terminations and site of care initiatives to drive better negotiated rates
- Managed the integration and re-negotiation of payer contracts across 11 corporate acquisitions between 2021 and 2024 that resulted in $12.8M in additional EBITDA contribution
- Worked with all major payers on total cost of care strategic initiatives to include site of care optimization, comprehensive formulary adjustments, value based arrangements and upside risk agreements, narrow networks and exclusivity arrangements that yielded a 31% increase in volume across the enterprise
- Provided strategic guidance to our private equity firm, CEO, CFO and the board regarding diligence efforts of companies under LOI for transaction to ensure revenue opportunity and integrity post close
- Created a corporate process to track expected pay with revenue cycle and finance to ensure payers were performing according to contract and quickly identifying, escalating and resolving payment issues in a timely fashion
- Reduced corporate payer bad debt from 18% in 2021 to less than 5% in 2024, this was primarily achieved by moving in-network and reducing patient out of pocket responsibility by achieving tier status with payers.
- Member of the Infusion Provider Alliance with significant responsibility in government relations and lobbying efforts with quarterly meetings in Washington DC
Director, Managed Care
Envision Healthcare
10.2019 - 11.2021
- Reporting to the VP of Managed Care over the central US, responsible for maintaining a managed care contract portfolio P/L of $300M in commercial and managed medicare / Medicaid revenue for all hospital based specialties across 15 states
- Performed contract negotiations from initiation to close for major and minor payers, both government and commercial, with extensive experience redlining and negotiating contract language, payer and provider terms, language stipulations and various reimbursement structures e.g. value based, capitation, flat rate, fee for service, budling, DRG or percentage of billed charges with an emphasis on maintaining revenue integrity
- Lead the managed care negotiations for all major and regional payers including complex arrangements such as VBC, capitated and DRG / carve out arrangements with hospitals
- Drafted the OON arbitration strategy for my region to include good faith offer proposals as a component to go to arbitration in 2022 under the No Surprises Act.
- Litigated multiple payers throughout my geography for under payment disputes, OON allowable disputes and contract violations with 100% success win rate totaling over 8-figures in settlement dollars.
- Strong contract language analytical skills with experience redlining all payer contracts both commercial and government contracts and negotiating changes to mitigate the overall risk
- Served as subject matter to the Emergency Medicine, Anesthesia, Radiology, Trauma and Women's and Children's service lines regarding reimbursement, compliance and managed care issues.
Education
Master's of Management in Healthcare -
Vanderbilt University
Nashville, TN09.2021
Bachelor of Science - Molecular Biology
Southern Illinois University Edwardsville
Edwardsville, IL2016
Skills
Payer Strategy & Negotiation
Network Management
Out of Network Arbitration
Out of Network Disputes
Contract Modeling
Financial Analytics
Redlining payer contracts
Expected pay mapping
Payer / Provider Disputes
Payment Policies
Reimbursement Methods
Risk Contracting, VBC, Capitation
Billing & Coding
Revenue Cycle Management
Credentialing & Enrollment
Affiliations
Member of the American College of Healthcare Executives
Member of the Healthcare Finance Management Association (HFMA)
Timeline
Chief Managed Care Officer
VIVO Infusion
11.2021 - Current
Director, Managed Care
Envision Healthcare
10.2019 - 11.2021
Master's of Management in Healthcare -
Vanderbilt University
Bachelor of Science - Molecular Biology
Southern Illinois University Edwardsville
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