Melissa Rodriguez
Executive Contract Negotiation
San Antonio,Texas
Summary
Energetic leader promotes over 15 years of industry experience with superior record of accomplishment. Ambitious and highly motivated executive surpasses demanding objectives and achieves or exceeds set goals. Currently manage high performance teams who provide content for revenue cycle and estimate producing products sold to healthcare organizations, to include IPAs, PHOs, hospital systems and ancillary providers. Have managed regional teams of high-level negotiators who negotiate complex contracts for hospital systems, facilities, ancillary providers and physician groups. Experience composing detailed strategies to provide solutions to improve competitive health plan payor market alignment. Worked extensively with sales and marketing departments, medical directors and executive management teams to develop strategies for increased product sales, determine provider network needs and appropriate network strategy to increase membership. Am proficient in establishing initiatives to determine cost thresholds for negotiations and locate medical cost savings within currently functioning and future functioning provider networks.
Overview
17
17
years of professional experience
1
1
Language
Work History
Sr Director, Payer Content and Contract Management
Experian Health
11.2020 - Current
- Lead and develop teams in a sales-oriented environment
- Charged to turn around low-growth operation by solidifying workflow processes, strengthening client relationships and improving communications supporting client advocacy.
- Develop underperforming teams into high functioning teams
- Lead and negotiate at C-Suite level, externally and internally in payer arenas
- Evaluate workflow processes to identify deficiencies and develop enhancements with my peers to standardize processes throughout the organization
- Ensure that organization standards are equal to or exceed regulatory requirements
- Implement corrective action plans to motivate employees to meet these standards
- Interview/hire new employees
- Identify trends and opportunity for improvement
- Provide leadership and motivation to employees by establishing expectations and communicating specific performance feedback in a timely manner
- Institute formal operating procedures and enforced adherence to policies and regulations that impact bottom-line.
- Prioritize and allocate valuable resources to meet business targets.
- Tasked to revamp operational plans to refocus staff and align processes with business objectives.
- Drive strategic improvements to enhance operational and organizational efficiencies.
Director, Network Management
Aetna Inc. of Texas
10.2018 - 11.2020
- Lead the design, development, management, and/or implementation of strategic network configurations to drive membership growth.
- Developed provider compensation/reimbursement schedules
- Provided leadership and motivation to employees by establishing expectations and communicating specific performance feedback in a timely manner
- Created annual budget and developed comprehensive plan to accomplish company objectives while staying within budget.
- Developed and executed negotiation strategies with providers that directly impacted positive financial growth for the healthcare organization
- Provided network strategy support to sales and marketing, along with assistance on community relations related items to achieve market and segment goals
- Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with health plan
- Experience with developing and maintaining Accountable Care Organization, Patient Care Medical Home and other value based contracting opportunities
- Oversaw and/or negotiated the most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies.
- Supported sales and retention efforts through finalist presentations and engagements with clients, prospects, brokers and consultants.
- Consulted with providers proactively to improve operational issues and provide education and training on companywide initiatives, new products, processes and regulatory standards.
- Advanced the company strategy to adopt value-based payment models; directly lead teams to develop, negotiate and manage complex Value Based and Accountable Care Organization (ACO) relationships.
- Focused teams on developing innovative and cutting-edge approaches with effective resource allocation and strategic planning.
- Worked closely with organizational leadership to strategically affect operational direction.
Manager, Network Management
Blue Cross Blue Shield of Texas
03.2018 - 10.2018
- Developed provider compensation/reimbursement schedules
- Provided leadership and motivation to employees by establishing expectations and communicating specific performance feedback in a timely manner
- Developed and executed negotiation strategies with providers that directly impacted positive financial growth for healthcare organizations
- Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with health plan
- Oversaw and/or negotiated most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies.
- Consulted with providers proactively to improve operational issues and provide education and training on companywide initiatives, new products, processes and regulatory standards.
- Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals.
- Onboarded new employees with training and new hire documentation.
- Delivered feedback to decision-makers regarding employee performance and training needs.
- Maximized performance by monitoring daily activities and mentoring team members.
Manager, Network Management
Aetna Inc. of Texas
04.2013 - 03.2018
- Developed provider compensation/reimbursement schedules
- Provided leadership and motivation to employees by establishing expectations and communicating specific performance feedback in a timely manner
- Developed and executed negotiation strategies with providers that directly impacted positive financial growth for healthcare organizations
- Responsible for reporting, understanding and managing medical cost issues and initiating appropriate action in partnership with health plan
- Experience with developing and maintaining Accountable Care Organization, Patient Care Medical Home and other value based contracting opportunities
- Negotiated most complex, competitive contractual relationships with providers according to prescribed guidelines in support of enterprise and local strategies.
- Consulted with providers proactively to improve operational issues and provide education and training on companywide initiatives, new products, processes and regulatory standards.
- Advanced company strategy to adopt value-based payment models
Director-Payment, Accounting and Revenue Services
Parallon Business Group
08.2012 - 04.2013
- Oversaw collection efforts from various health plans for Methodist Hospital System and St David’s Hospital System.
- Analyzed business needs while soliciting customer feedback for process improvements.
- Provided documentation of processes to comply with regulations and company policies.
- Delegated assignments based on plans, project needs and knowledge of individual team members.
- Collaborated with management and fellow supervisors to organize operations and achieve demanding schedule targets.
- Hired and directed teams to achieve daily and long-term operations and business goals.
- Assisted company executives during decision-making process by compiling daily reports to suggest corrective action.
Network Manager
Aetna Inc. Of Texas
07.2007 - 08.2012
Education
Bachelor of Arts - Pre-Law
St. Mary's University
San Antonio, TXSkills
Complex Contract Negotiations Market Financial Analysisundefined
Timeline
Sr Director, Payer Content and Contract Management
Experian Health
11.2020 - Current
Director, Network Management
Aetna Inc. of Texas
10.2018 - 11.2020
Manager, Network Management
Blue Cross Blue Shield of Texas
03.2018 - 10.2018
Manager, Network Management
Aetna Inc. of Texas
04.2013 - 03.2018
Director-Payment, Accounting and Revenue Services
Parallon Business Group
08.2012 - 04.2013
Network Manager
Aetna Inc. Of Texas
07.2007 - 08.2012
Bachelor of Arts - Pre-Law
St. Mary's University
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