Allan Sanchez

About Allan Sanchez

Summary of Qualifications • Over 20 years’ experience in managed care contracting. From review of enrollment data through cold calling and lead pursuit, negotiating Hospital, Primary and Specialty providers, Behavioral health and Lab/DME entities through to onboarding and orientation on behalf of Ancillary and IPA networks. • Skilled with developing strategies to improve effective coverage using quantitative Analytics, measuring health outcomes versus the cost of chronic management. Taking internal data and enrollment from health-plan sourced material to develop agreements using various methodologies such as Value based Pricing, traditional fee for service, bundled services, case rates, tiered pricing and full or partial capitation. • Managed complex contract language review and participated in Joint Operation Meetings to discuss issues relative to downstream participants, updating the progress of service issues with the timeline for resolution. • As Director, I have facilitated Project Management with contracting specialist personnel; assigning resources to meet objectives. Staff included credentialing specialists and provider relations/support personnel. Also acted as a mentor for the team to further advance their skills and knowledge. Contract Language ICD-10 Coding Risk Assessment/Research Planning Policy and Procedure Development Hospital, Ancillary Contracting Experience Value Based Pricing experience Medicaid/Medicare experience Team Leader/Resource Developer Project Direction Contract Management Complaint Resolution PLEASE NOTE: I AM NOT INVOLVED IN INFORMATION TECHNOLOGY OR IT NETWORKING

Experience

1. Manager Provider Network Management

   Elevance Health

   Nov 2019 — Present · CA

   Directed a team of Contract Managers for the Professional PPO Network for the State of California. The team consisted of Senior & Mid-Level managers experienced with Professional and Behavioral Health services as well as Medicare Advantage PPO/Medicaid LOB for select services. Worked alongside my managers in contract fee discussions to avoid member abrasion and addressed recruitment projects for Narrow Networks and Urgent Care Access in rural/geographically challenging regions as part of DMHC/State of CA mandates. Supervised Value Based and Quality Incentive Programs, tying in fee adjustments with targeted stipulations for BH Groups larger than 100 practitioners. Responsible for Cost of Care Initiative which tracked the savings provided to our clients by our LOA team when Anthem did not have a Network alternative, saving $4-5 million annually from billed charges. Reviewed Quantitative and Qualitative Reporting from my team in my 1:1 meetings and conducted annual Performance Evaluations in which goals were established & tied into bonuses & advancement. Served as Committee Member reviewing assignment of Providers to Prepayment review by SIU to ensure Contract compliance. Held frequent meetings with managers in multiple states to review the impact to contracted entities with revisions to Policy and Procedures. Additionally, worked on projects requiring collaboration with multiple teams on specific projects affecting the Enterprise.