C. Daniel Koon

Experience

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  Technology Management, Inc.

  Jan 1992 - Jan 1995

  Manager - Consulting

  Assisted clients with strategy in Health Care Operations and Technology.

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  DanCor Technology

  Feb 1995 - Jun 1995

  President

  Represent client hospitals and providers in contractual language and reimbursement negotiations with all major payors.Develop managed care strategies for clients.Perform Clinical Integration readiness analysis for client organizationsDevelopment team member for The Godbey Report, an analysis tool to allow hospital various reimbursement measurements against national averages by major payors.Joint responsibility for new client growth

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  PacifiCare Health Systems - SE Region

  Apr 1995 - Feb 1997

  Acting CEO

  Responsible for all HMO functions for Commercial, Medicaid, and Medicare products.

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  PacifiCare of New Jersey

  Feb 1997 - Sept 1999

  Responsible for establishing a startup Medicare HMO in New Jersey with full P&L responsibility. Developed final budgets and a 3-year business plan and worked with state regulators and the Securities and Exchange Commission to obtain the necessary regulatory approvals for this new venture. Management, with full P&L responsibility, of all HMO group model functional areas including the operation of 5 Clinics for medical/dental delivery with a clinical and support staff of 275 and HMO administration staff of 75.

  • Plan President

    Jun 1999 - Sept 1999

  • Plan President

    Feb 1997 - May 1999
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  PacifiCare of TX - Harris Methodist Health Plan

  Oct 1999 - Mar 2001

  General Manager

  Managed the State and Federal regulatory approval and integration of the 350,000-member Harris Methodist Health Plan with full P&L responsibility into PacifiCare Texas with a budget of $13.3 million, on schedule and favorable to budget by $1.5 million. Spokesperson for monthly PacifiCare of Texas Town Hall meetings for 200,000 Secure Horizons Medicare members.Converted 2700 direct physician contracts to capitated group contracts & eliminated 3000 direct contracts and completed 8 Capitated physician group contractsProvider Network Management and Provider Relations for PacifiCare - North Texas. Responsible for the Medical Management and Quality Improvement. All Medical Directors and medical staff reported to this Show less

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  DanCor Technology Incorporated

  Mar 2001 - Mar 2002

  President

  Assisted in 25% growth of new physicians for a Houston Primary Care Physician Network. Managed a diagnostic imaging company in the development of capitated HMO and individual contracts.Review of Sutter Health Plan's project plan for Data Center relocation

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  Kaiser Permanente Insurance Company & Kaiser Foundation Health Plan

  Apr 2002 - Feb 2007

  Network Management

  Provider Contracting Identified contracting methodology to save Kaiser Permanente $40m annuallyResponsible for all national health care delivery contracts for the Kaiser Permanente Point of Service, Preferred Provider Organization and Out of Area productsResponsible for Visiting Member Out of Network secondary physician & facility contracts covering all Kaiser Regions Provider Network Management and Provider Relations for Kaiser Permanente Insurance Co. - 1500 direct contracts in Hawaii network Assisted KPIC in the selection and project managed the transition of the POS & PPO TPA functions to a new vendor. Show less

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  HealthFirst - St. John's Regional Medical Center

  Feb 2007 - Nov 2008

  CEO

  CEO of HealthFirstResponsible for PHO contracting for St; 13 independent hospitals and 400 independent providers in the SW Missouri, SE Kansas and NE Oklahoma areaIncreased facility payments from managed care over 10% in 18 monthsIncreased physician reimbursement from managed care contractsResponsible for PHO Sales, Marketing, Account Management for carrier and directly contracted groups.Grew managed care membership by 10% in 18 monthsStrategic planning for PHO and implementationRe-established physician involvement and trust in PHOResponsible for Government Affairs/Government Relations for HealthFirst and St; Missouri House of Representatives passed Any Willing Provider legislation - Failed in Senate Show less

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  Godbey Group

  Feb 2009 - Jun 2010

  Managing Director

  Represent client hospitals and providers in contractual language and reimbursement negotiations with all major payors.Develop managed care strategies for clients.Perform Clinical Integration readiness analysis for client organizationsDevelopment team member for The Godbey Report, an analysis tool to allow hospital various reimbursement measurements against national averages by major payors.Joint responsibility for new client growth

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  HTMS, an Emdeon Company

  Jun 2010 - Jul 2015

  Senior Consultant

  Senior consultant with HTMS. Focus on health plan operations, provider network management and development and project management. Various clients across the US with engagements ranging from project management, operations to network management strategy and creation. Experienced in all health plan products including Commercial, Medicare, Medicaid and ACA.

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  DanCor Technology

  Jan 2015 - now

  Managing Consultant

  Network Strategy & Operations focused healthcare consulting. Engagements:- CMS compliant network development for a California Medi-Cal plan developing Medicare D-SNP plan for 2026- Network Payor network development - Telehealth start-up - California- Network development - Adequacy, Reimbursement for a Medicare Advantage start-up plan - Chicago, IL - Kingdom of Saudi Arabia: Participating Provider contract development for Saudi citizens seeking health care in the United States- Medicaid Dental network development - Texas Medicaid health plan - Illinois health plan: Hospital and Physician recruiting for state wide Medicaid network expansion and part of a 7 member team to develop RFP response to state of IL for Medicaid expansion.- Alabama (Medicaid start up): network development with concentration on hospital and physician contracting.- Illinois health plan: Medicaid and ACA network development Show less