Michelle Holden
McDonough,GA
Summary
Goal-oriented healthcare professional with 20+ years in managed care, specializing in contracting, credentialing, and provider relations. Proven success in negotiating contracts, driving value-based strategies, and fostering cross-functional collaboration to improve access and outcomes.
Overview
24
24
years of professional experience
Work History
Senior, Payor Relations Specialist
Northside Hospital
Atlanta, GA
04.2021 - 03.2025
- Negotiated complex hospital contracts, achieving a 12% reduction in service costs by leveraging advanced market analysis and cross-functional collaboration.
- Led continuous improvement initiatives with finance and operations, optimizing contract workflows.
- Acted as primary liaison to payers, ensuring timely resolution of claims disputes.
Provider Network Manager
NJM Insurance Group
West Trenton, NJ
12.2019 - 04.2021
- Expanded the provider network by 20% by identifying strategic partners and negotiating new contracts.
- Implemented continuous improvement initiatives that optimized provider cost structures, achieving a 15% reduction in inefficiencies.
- Collaborated cross-functionally with legal and operations to align contract strategies.
Hospital Account Executive
Horizon NJ Health Government Programs
West Trenton, NJ
04.2016 - 01.2019
- Negotiated value-based contracts, improving cost efficiency by 10% through advanced data modeling.
- Influenced change by guiding cross-functional teams in new value-based care programs, achieving a 95% partner engagement.
- Collaborated with external partners to enhance provider access and member outcomes.
Manager, Provider Recruitment
MagnaCare
Westbury, New York
10.2013 - 04.2016
- Supervised provider recruiters, increasing network adequacy by 15% through strategic recruitment.
- Developed policies and collaborated with Sales/Marketing to align recruitment strategies with business goals.
Network Contractor
MagnaCare
Tinton Falls, New Jersey
07.2012 - 10.2013
- Negotiated contracts with ancillary groups, increasing services by 10% by ensuring cost viability.
- Built strong partnerships to support sales growth and maintained positive provider relationships.
Network Manager
Healthfirst NJ
Newark, New Jersey
09.2009 - 06.2012
- Managed physician network growth by 18% through targeted recruitment and retention.
- Negotiated competitive contract rates, achieving a 10% cost reduction, and resolved complex provider service issues.
Provider Services Representative
Horizon NJ Health Government Programs
West Trenton, NJ
06.2006 - 04.2009
- Developed and maintained relationships with participating providers in assigned territory.
- Educated and engaged network providers in the implementation of CMS quality improvement programs (STARS/HEDIS/QARR).
- Interacted with physicians and their office staff to maintain high satisfaction.
- Conducted on site visits to provider practices in support of network development and retention efforts.
Provider Services Representative
University Health Plans
Newark, New Jersey
09.2003 - 05.2007
- Supervised Provider Service Representatives.
- Trained, coached and provided feedback to Provider Service Representatives.
- Handled supervisor level phone inquiries.
Provider Relations Representative
Aetna
Fairfield, New Jersey
12.2000 - 09.2003
- Developed and maintained the provider network in Northern New Jersey.
- Scheduled regular face to face visits with provider offices to identify any issues and ensure plan visibility.
- Conducted orientation for Primary Care Physicians and Specialists.
Education
Bachelor of Science - Public Administration
Kean University
Union, NJ01-2009
Skills
- Contract Strategy & Negotiation
- Continuous Improvement Initiatives
- Cross-Functional Collaboration
- Value-Based Contracting
- Provider Recruitment & Network Growth
- Strategic Planning
- Provider Education & Satisfaction
- Claims & Dispute Resolution
Timeline
Senior, Payor Relations Specialist
Northside Hospital
04.2021 - 03.2025
Provider Network Manager
NJM Insurance Group
12.2019 - 04.2021
Hospital Account Executive
Horizon NJ Health Government Programs
04.2016 - 01.2019
Manager, Provider Recruitment
MagnaCare
10.2013 - 04.2016
Network Contractor
MagnaCare
07.2012 - 10.2013
Network Manager
Healthfirst NJ
09.2009 - 06.2012
Provider Services Representative
Horizon NJ Health Government Programs
06.2006 - 04.2009
Provider Services Representative
University Health Plans
09.2003 - 05.2007
Provider Relations Representative
Aetna
12.2000 - 09.2003
Bachelor of Science - Public Administration
Kean University