Marshall Evans

About Marshall Evans

Resilient, resourceful, and collaborative healthcare people leader experienced in payor and provider operations. Majority of experience is in provider network management, including provider education and relationship management, provider contracting, and network management program operations.Provider Relationship Management• Payor Product, Policy, Program, Reimbursement, and Process Education• Primary Care, Specialty Care, Ancillary Care, and Health System Relationship Management• Key Providers: East Carolina University Physicians, Physicians East, Vidant HealthProvider Contracting• Commercial and Medicare Advantage New Contract Development• Primary Care, Specialty Care, Ancillary Care Experience• Professional Reimbursement Analysis and Negotiation• Optum Contract Manager and Provider Manager Software ExperienceNetwork Management Program Operations• Affordable Care Act (ACA) Commercial Network Adequacy Monitoring & Reporting• ACA Commercial Network Development• CMS Qualified Health Plan (QHP) Certification• Provider Network Strategy, Optimization, Curation, Audit, and Reporting Support• No Surprises Act (NSA) Open Negotiation & Independent Dispute Resolution (IDR)• NSA Open Negotiation and IDR Strategy Development and Execution• NSA Workflow Development and OversightLeadership PhilosophyI implement a thoughtful and proactive approach to leadership, aimed at creating conditions for sustainable success.Team: Identify & develop high character, resourceful, critical thinking, problem solvers.Vision: Develop strategic direction and goals.Excellence: Exemplify a pursuit of excellence – communication, preparation, presentation.Track: Measure performance and embrace accountability.Serve: Exhaust all resources, connections, and skills to equip, develop, and elevate others.Love: Demonstrate genuine compassion, empathy, grace, and personal investment.Core CompetenciesLeadership | Relationship Management | Provider Contracting | Network Development & AdequacyData Analysis | Process Improvement | Team Development | Strategic Planning | Workflow RedesignTechnology CompetenciesOptum Contract & Network Provider Manager | Salesforce | Quest Analytics | Microsoft Office Suite

Experience

1. Team Lead, Provider Network Program Operations

   Blue Cross NC

   Feb 2024 — Present · Durham, NC, US

   Currently managing a team of seven program management professionals responsible for representing Blue Cross and Blue Shield of North Carolina in the negotiation and arbitration processes outlined by the federal No Surprises Act (NSA). Effective January 1, 2022, the NSA established significant protections against surprise medical bills for commercial group and individual health plan members. Our team works with internal and external stakeholders to conduct out-of-network rate negotiations and engage in federal independent dispute resolution in surprise billing situations. Additional responsibilities include conducting enterprise-wide surprise billing education and reporting, supporting ad hoc surprise billing projects, and ensuring compliance with federal regulations.Responsible for the Blue Cross and Blue Shield of North Carolina surprise billing workflow development and oversight, program strategy ideation and execution in support of team, division, and enterprise-wide objectives and compliance standards, and developing, monitoring, and achieving key performance indicators to drive business outcomes.

Education

• Liberty University

  Master of Business Administration - MBA

  2016 — 2018

• Liberty University

  Bachelor of Science - BS, Exercise Science: Pre-Professional

  2012 — 2016