Melli Vargas
Northridge
Summary
To obtain a responsible and rewarding position that will fully utilize skills, knowledge and expertise. Position should provide a challenge and opportunity for advancement.
More than 30 years of experience in the medical field. Knowledge in Managed Care, PPO, POS, EPO, Medicare, Medi-Cal a worker’s compensation, government agencies compliance. Well organized with efficient decision-making capabilities and exceptional communication skills. Negotiations on capitated and stipend agreements for specialists, network development for various counties throughout California. Managed to move approximately 75K members through the years, including high senior enrollment. DEI Committee member for the Southern California Region for a large organization.
Overview
24
24
years of professional experience
Work History
Manager, Provider Network Development / Program Manager
Providence Affiliated Physicians
12.2019 - 02.2025
- Physician recruitment for Primary Care Physicians
- Vetting for new opportunities, Primary Care Physicians
- Contracting negotiations
- Assisting affiliated hospitals in obtaining specialists to perform procedures in their facilities
- Assist peers in negotiations with physicians with other networks
- Maintaining a good network and high performing physicians for higher profits
- Employers and Community events for LA, OC and Ventura Counties
- Supervised Network Relation Representative
Senior Network Manager
Regal Medical Group
07.2013 - 11.2019
- Collaborate with hospitals and providers to develop operational plans to increase growth and strengthen physician network panels
- Recruiting physicians specialists and Primary Care Physicians
- Negotiating contracting for Ancillary, pcps, specialists and ASC facilities to reduce IPA expenses
- Contracts re-negotiation for existing providers
- Ensure providers satisfaction
- Specialists Capitation Agreements
- Exclusivities contract negotiations for Primary Care Physicians
- Supervising Coordinators to ensure network accuracy for health plans submission as well as training Field Network Managers and providing support for contracting negotiation for specialists
- Training new employees
- Participated in the Credentialing and QA committee meetings
Business Network Manager
Synermed
Monterey Park
12.2007 - 06.2013
- Negotiate contract including (Ancillary, PCP, Specialist, and Hospital) and re-negotiate existing contracts with vendors
- Collaborate with hospitals and providers to develop operational plans to increase growth and strengthen physician network panels
- Recruited new provider to network through Marketing and Development
- Provided oversight and ensured provider issues were properly resolved and pertinent matters were relayed back to upper management
Provider Services Representative
Valley Presbyterian Hospital
Van Nuys
11.2006 - 10.2007
- Physician Recruitment / Retention
- Provider / Staff Education
Provider Services Representative
Preferred IPA of California
Glendale
07.2001 - 10.2006
- Network Development / Physician Recruitment
- Provider / Staff Education in Policies and Procedures as well as pre-audits
- Negotiation and implementation of Physician and Ancillary Contracts
- Specialty listings updates
Business Office Administrator
CareMore Medical Group
Downey
09.2000 - 06.2001
- Supervised Billing/Collection Department – 18 employees
- Credentialing for PPOs insurance companies and government agencies
- Responsible for practice management accounts receivables
- Third party liability accounts and workers compensation
Education
Some College (No Degree) - Psychology
Pierce College
Woodland Hills, CASkills
- Word
- Excel
- EZ Cap
- Act!
- AS400
- Dynamics CRM 365
- MS Teams
- Physician recruitment
- Contract negotiations
- Network development
- Provider satisfaction
- Operational planning
- Market analysis
- Employee training
- Regulatory compliance
- Relationship building
- Conflict resolution
- Coaching and mentoring
- Brand management
- Marketing
- Time management
- Negotiation
- Customer service
- Networking strategies
- Partnership development
- Business development
References
Available upon request
Languages
- Fluent English
- Fluent Spanish
Phone
cell, (818) 445-9718
Timeline
Manager, Provider Network Development / Program Manager
Providence Affiliated Physicians
12.2019 - 02.2025
Senior Network Manager
Regal Medical Group
07.2013 - 11.2019
Business Network Manager
Synermed
12.2007 - 06.2013
Provider Services Representative
Valley Presbyterian Hospital
11.2006 - 10.2007
Provider Services Representative
Preferred IPA of California
07.2001 - 10.2006
Business Office Administrator
CareMore Medical Group
09.2000 - 06.2001
Some College (No Degree) - Psychology
Pierce College