Edward Vargas
San Antonio,Texas
Summary
Visionary healthcare executive with over 30 years of experience transforming operations, driving strategic growth, and forging high-impact partnerships. Proven track record in enhancing operational efficiency, expanding services, and improving patient satisfaction through innovative strategies and leadership. Skilled in managing large teams, optimizing processes, and negotiating favorable contracts. Committed to delivering high-quality patient care and operational excellence through strategic vision and data-driven decision-making.
Overview
35
35
years of professional experience
Work History
Chief Operating Officer
Flagship Health
San Antonio, Texas
03.2023 - Current
- Optimized revenue cycle, boosting net revenue by 9% and reducing claim denials by 6%, increasing from $350,000 to $402,500 in Year 1 and $482,875 year-to-date in Year 2
- Transitioned from fee-for-service to capitation, leveraging arbitrage to boost net revenue by 15% (from $350,000 to $402,500) in Year 1, and to $410,701 year-to-date in Year 2, creating a fixed income
- Increased HEDIS measure compliance by 43% by running reports to identify gaps prior to patient appointments
- Improved HEDIS gaps by 7% and operational efficiency ratio by 11%, raising staff productivity by 4%
- Managed a $4.3 million annual budget, ensuring financial sustainability
- Grew Medicare Advantage membership by 108% in Year 1 (from 313 to 651 members) through targeted outreach and partnerships, achieving a customer acquisition cost of $476 per member
- In Year 2, membership grew to 925 members year-to-date, an additional 42.1% from Year 1, and overall 195.5% from the initial 313 members
- Facilitated clinic acquisition, developing a non-disclosure agreement and proforma for EBITDA assessment
- Led de novo clinic development, overseeing budgets, site selection, design, lease negotiation, IT integration, and staffing.
Texas Vice President of Operations
Cano Health Texas
San Antonio, Texas
04.2020 - 12.2022
- Managed a $33.24 million profit and loss statement, achieving 15% annual revenue growth through strategic financial oversight and resource allocation
- Increased Medicare Advantage membership from 0 to 1,300 in the first year and grew by another 1,800 members in the second year, demonstrating effective market penetration and growth strategies
- Implemented strategic plans, reducing patient wait times by 30%, enhancing operational efficiency and patient satisfaction
- Monitored key performance indicators, improving Net Promoter Score to 83 and Consumer Assessment of Healthcare Providers and Systems score to 7, showcasing a commitment to continuous performance improvement
- Integrated multi-specialty services (dental, physiotherapy, x-ray, wellness, heart health), increasing service utilization by 15% through comprehensive care delivery
- Cultivated partnerships, increasing patient referrals by 20%, strengthening community and stakeholder relationships
- Identified and developed locations for new clinics, resulting in an 11% increase in market share upon their opening, showcasing strategic expansion and operational planning capabilities.
Director of Bundled Payments
Anthem Health Plans
San Antonio, Texas
03.2018 - 04.2020
- Implemented innovative multi-state bundled payment programs using Bundled Payments for Care Improvement and Prometheus definitions, saving $3.2 million by streamlining reimbursement processes
- Implemented bundled payment models, negotiating risk allocation for procedures (e.g., knee replacements), achieving 22% average savings
- Negotiated bundled payment contracts with providers and employer groups, resulting in 20% savings for employer groups
- Utilized data analytics to assess program performance, generating reports for senior leadership and stakeholders
- Educated providers on bundled payment methodologies, enhancing program adherence.
System Director of Business Development
CHRISTUS Spohn Health System
Corpus Christi, Texas
10.2013 - 03.2018
- Revitalized the Spohn Health Network (PHO), increasing revenue by 11% from $1.35 million to $1.498 million through targeted strategic initiatives and programs, resulting in a 9% increase in patient volume
- Implemented initiatives that boosted profit margins by 18.76%, contributing to an overall cost reduction of 10%
- Negotiated and executed managed care contracts for previously unavailable services, leading to a 16.74% increase in PHO membership and a 12% reduction in patient transfer rates
- Collaborated with marketing to develop strategies, resulting in an 11% increase in self-insured business and a 15% rise in client and broker satisfaction due to the comprehensive network and competitive pricing for health services
- Monitored financial performance and implemented cost control measures, increasing profitability by 18% and reducing overhead costs by 12%
- Developed and managed budgets for business development initiatives, ensuring financial sustainability and optimal resource allocation, achieving a 95% budget adherence rate
- Advised C-Level executives on managed care relationships and strategic business initiatives, enhancing decision-making and operational alignment, leading to a 12% improvement in strategic project completion rates
- Increased community engagement by 20% through outreach activities, establishing an office manager council, and conducting seminars on PHO and managed care topics for provider staff, resulting in a 25% rise in community health awareness participation
- Recruited providers into the PHO to support service line development, expanding service offerings by 10% and decreasing patient wait times by 15%.
Network Administrator
Cigna/HealthSpring
McAllen, Texas
10.2012 - 10.2013
- Expanded the provider network by 65 in the Rio Grande Valley (from 573 to 638) and by 38 in the Laredo market (from 348 to 386), achieving an 11.34% and 10.92% increase respectively, which improved patient access to care
- Managed and maintained relationships with healthcare providers, ensuring a 95% provider satisfaction rate and efficiently resolving network operations issues, leading to a 20% decrease in provider complaints
- Ensured network adequacy by monitoring provider availability and accessibility, maintaining a 100% compliance rate with network adequacy standards, resulting in uninterrupted patient services
- Negotiated and renewed provider contracts, achieving a 95% renewal rate, which stabilized the network and secured continuous service provision
- Analyzed network performance data to identify trends, gaps, and opportunities for improvement, implementing strategies that increased network efficiency by 15%, thereby reducing operational costs by 8%
- Conducted training sessions for over 200 providers, enhancing their understanding of network requirements and claims processes, which resulted in a 20% reduction in claims processing time and a 15% improvement in claims accuracy.
Regional Vice President of Network Development
Health Smart Preferred Care Inc.
McAllen, Texas
03.2007 - 10.2012
- Negotiated hospital contracts at competitive pricing, achieving a 4% decrease in overall rates (from $23 million to $22.08 million) and a 7% reduction in group-specific rates (from $4.5 million to $4.185 million), enhancing cost efficiency
- Leveraged expertise in provider contracting to meet network needs, reducing overall healthcare costs for clients by 1.5% (from $45 million to $44.325 million) and improving client satisfaction
- Developed and maintained C-Suite relationships with key hospital and group practice administrators, achieving a 100% contract renewal rate and ensuring network stability
- Expanded network reach by 5% by contracting with a hospital and providers previously not in the network, increasing patient access to care
- Managed relationships with municipalities, including school boards, city councils, and county commissioners’ courts, achieving a 100% client renewal rate and strengthening community ties.
Nursing Home Administrator
Skilled Healthcare LLP
McAllen, Texas
07.2002 - 09.2004
- Directed daily operations of a 194-bed nursing and rehabilitation facility, managing a budget of $13.7 million in annual revenue and supervising 5 direct and 134 indirect employees, ensuring high standards of care
- Achieved a CMS Quality Measures Rating of 4 stars, with QIPP Metrics: Pressure Ulcer Reduction at 90%, Antipsychotic Medication Use at 85%, and Mobility Improvement at 75%, demonstrating excellence in patient care
- Increased net revenue by 5% through renegotiating payer rates, securing favorable single case agreements, and implementing cost-saving measures, contributing to financial stability
- Met MDS Quality Measures: Falls at 10%, Pain Management at 90%, Urinary Tract Infections at 5%, and Restraint Use at less than 2%, maintaining high standards of patient safety and care
- Reduced budgeted PPD in medical equipment and supplies, dietary, and labor costs by 4.7%, enhancing operational efficiency and cost control
- Developed emergency preparedness plans and streamlined the admissions process, reducing assessment and notification time by 49% (from 45 to 23 hours), improving response efficiency
- Directed a 9-month maintenance project, resolving infrastructure issues and refurbishing rooms, ensuring a safe and comfortable environment for residents.
Business Development Specialist
Brownsville Medical Center
Brownsville, Texas
05.1997 - 07.2002
- Developed and executed strategic business development plans, resulting in a 1.8% increase in operating income, enhancing financial performance
- Re-established the PHO, increasing membership from 53 to 103 members, achieving a 94% growth in network size, and expanding patient care capabilities
- Recruited approximately 18 physicians to meet community needs for specialty services, enhancing the hospital's service offerings and improving patient care
- Established a credentialing and contract review committee, increasing PHO contract revenue by 8%, ensuring quality and compliance
- Negotiated emergency department coverage agreements for orthopedic services, ensuring continuous staffing and uninterrupted patient care
- Collaborated with the marketing team to conduct market research and develop strategies, resulting in a 10% increase in patient volume, improving hospital utilization
- Monitored key performance indicators (KPIs) monthly, managing costs per procedure against expected reimbursements to optimize financial management and ensure profitability
- Managed the leasing of Medical Office Building (MOB) space, achieving 60% occupancy during construction, maximizing revenue potential
- Executed strategies and business dealings with the physician community according to the direction of the CEO, leveraging existing relationships to support hospital initiatives.
Provider Contractor (HMO Plan)
Early Roles
01.1995 - 04.1997
- Negotiated and managed contracts with healthcare providers, ensuring compliance with HMO standards and optimizing network efficiency.
Provider Relations Representative
Early Roles
06.1993 - 12.1994
- Maintained and strengthened relationships with healthcare providers, addressing concerns and facilitating effective communication.
Claims Customer Service
Early Roles
01.1991 - 05.1993
- Provided support and resolution for claim inquiries, ensuring accuracy and efficiency in processing.
Claims Processor
Early Roles
06.1989 - 12.1990
- Processed claims with a 99% accuracy rate, ensuring timely and correct reimbursements.
Education
Master of Healthcare Administration -
Webster University
Bachelor of Healthcare Administration -
Wayland Baptist University
Skills
- Strategic Healthcare Leadership
- Operational Efficiency & Quality Improvement
- Process Improvement
- Mergers & Acquisitions
- Healthcare Financing
- Profit and Loss Management
- Payer Contract Negotiations and Relations
- Clinic, Hospital, and Skilled Nursing Facility Operations
- Network and Business Development
- Market Expansion
- EMR and Technology Services Proficiency
- Healthcare Analytics and Performance Metrics
- Stakeholder Relationship Management
- Physician Relationship Development and Maintenance
- Medicare, Medicaid, ACA, Commercial Growth Strategies
Affiliations
American College of Healthcare Executives (ACHE)
Timeline
Chief Operating Officer
Flagship Health
03.2023 - Current
Texas Vice President of Operations
Cano Health Texas
04.2020 - 12.2022
Director of Bundled Payments
Anthem Health Plans
03.2018 - 04.2020
System Director of Business Development
CHRISTUS Spohn Health System
10.2013 - 03.2018
Network Administrator
Cigna/HealthSpring
10.2012 - 10.2013
Regional Vice President of Network Development
Health Smart Preferred Care Inc.
03.2007 - 10.2012
Nursing Home Administrator
Skilled Healthcare LLP
07.2002 - 09.2004
Business Development Specialist
Brownsville Medical Center
05.1997 - 07.2002
Provider Contractor (HMO Plan)
Early Roles
01.1995 - 04.1997
Provider Relations Representative
Early Roles
06.1993 - 12.1994
Claims Customer Service
Early Roles
01.1991 - 05.1993
Claims Processor
Early Roles
06.1989 - 12.1990
Master of Healthcare Administration -
Webster University
Bachelor of Healthcare Administration -
Wayland Baptist University
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