brian vines

Responsible for all aspects of provider network build, contract strategy, negotiations, operations, and services with various provider types. Led a network expansion team to contract hospitals, physicians, ancillary, and behavioral health providers for PPO, HMO, Medicare, and Medicaid networks, achieving cost savings targets. Developed comprehensive contract management processes and strategic part

Oversaw all aspects of provider network development for North America, leading and developing a network team to drive profitability and market saturation. Developed new PPO and HMO networks through direct contracts and wrap networks, managing over $260 million in annual claims volume. Negotiated hospital and provider contracts, including specialty networks, established key metrics, and ensured com

Served as Client Manager for Healthy Kids, Long Term Care, and Medicaid lines of business, responsible for network development, contracting, credentialing, and claims resolution. Developed provider application intake procedures, reducing data collection redundancy by 43%, and managed Provider Relations liaisons, achieving 100% NCQA standards compliance. Coordinated the launch of the "Healthy Kids"

Managed the network expansion team, overseeing procurement, negotiations, contract development, management, compliance, and reporting. Successfully developed provider networks in 10 states for Medicaid members across Home Health, Home Infusion, and Durable Medical Equipment. Negotiated and re-negotiated high-level contracts, executed cross-functional network strategies, and managed GEO Access Repo

Worked with the Vice President of Provider Relations to create and implement strategies for building the Medicare Advantage provider network through recruitment and contract negotiations. Developed a strategic plan that increased member enrollment by 47% by enabling nurse practitioners as primary care providers. Negotiated Medicare Physician and Hospital contracts using various pricing methodologi

Managed the South Texas territory, establishing and maintaining provider relationships while contracting and credentialing new providers including hospitals, ancillaries, and physicians. Developed a plan for a paperless credentialing department, resulting in a $1 million cost reduction, and built a provider network for the Tricare bid. Negotiated and re-negotiated physician contracts for Commercia