Tracy Marie Vargo
Akron,OH
Summary
Aspiring professional eager to leverage expertise in provider contracting, engagement, education, compliance, policy, risk, and quality to enhance effective, timely care delivery within evolving healthcare landscape
Overview
32
32
years of professional experience
Work History
Contract Coordinator/Credentialing
Akron General Network Health Group
11.2000 - 07.2002
- Directed management of Payer contracts, optimizing operational workflows.
- Implemented provider engagement strategies through targeted education initiatives.
- Conducted thorough provider credentialing to guarantee qualifications.
- Nurtured Payer relationships to foster mutual growth and understanding.
Program Manager Medicare Stars/Quality
Molina Healthcare (Enterprise)
07.2022 - 09.2025
- Directed Medicare Quality Bonus Programs, focusing on Stars and MMP Quality Withhold compliance.
- Ensured alignment with Federal and state regulations governing Duals (DSNP & MMP).
- Led policy and procedure development to support compliance initiatives.
- Engaged cross-functional teams in Medicare Stars, Network Management, VBCs, and Provider Engagement.
- Enhanced community relations through proactive stakeholder engagement.
- Implemented strategies to uphold CMS compliance mandates.
- Optimized operations to boost efficiency in program administration.
- Reviewed regulatory updates to ensure continuous compliance.
Sr. Provider Contract Manager
Medical Mutual of Ohio
09.2020 - 07.2022
- Directed contractual performance relationships with multiple health systems including University Hospitals and MetroHealth.
- Executed contract negotiations emphasizing precise language and financial agreements.
- Analyzed financial data to support informed decision-making in contract management.
- Worked closely with MedEcon to ensure project success and adherence to goals.
- Hosted Joint Operating Committees (JOCs) for improved communication and cooperation.
- Established Value-Based Care (VBC) models and Bundle Payments to enhance efficiency.
- Assured network adequacy for healthcare providers throughout Northeast Ohio.
Network Program Manager
United Health Group – Optum Health
03.2018 - 09.2020
- Managed network operations in Northeast Ohio, focusing on provider engagement and education.
- Conducted comprehensive reviews of coding and documentation to ensure accuracy.
- Enhanced practice performance through strategic risk adjustment initiatives.
- Led HEDIS and Stars programs to improve quality metrics.
Sr. Provider Network Manager
Anthem Inc.
05.2016 - 02.2018
- Directed network management across Northern Ohio, focusing on large health systems such as Steward, Mercy Health, and ProMedica.
- Facilitated compliance with Value-Based Agreements across various lines of business.
- Collaborated with Provider Economics to establish competitive rates and terms.
- Led Joint Operating Committees to drive strategic initiatives and stakeholder engagement.
Sr. Contract Negotiator
Moda Health, Inc
05.2014 - 05.2016
- Managed network and larger systems across Washington, Oregon, and Alaska.
- Oversaw relationships and contracting with health systems, ancillary services, air ambulance operations, and provider groups.
- Conducted financial analytics to support value-based care and bundle payments. Negotiated contracts utilizing various reimbursement methodologies.
- Developed strategies for commercial, Medicaid, Medicare, and marketplace reimbursement processes.
Network Manager
Optum Behavioral Health/UHG
09.2012 - 05.2014
- Managed Behavioral Health Network in Washington across all lines of business.
- Ensured network adequacy for Medicaid, Medicare, and commercial lines of business.
- Provided analytical reports to state authorities to support decision-making.
- Conducted Joint Operating Committees to enhance collaboration among stakeholders.
- Negotiated contracts with behavioral health providers to optimize service delivery.
Network Manager, Contracted
United Healthcare
05.2011 - 09.2012
- Key responsibilities included Network management for all LOB in Washington, contract negotiations, multiple reimbursement methodologies; Provider issue resolution; network adequacy to ensure RFP for state of Washington’s Medicaid product.
PHO Provider Representative
Akron City Health System PHO & SummaCare Health Plan
04.1997 - 11.2000
- Oversaw all Payer contracts with PHO to ensure compliance and efficiency.
- Developed policies and procedures for ACHS PHO, enhancing operational protocols.
- Led provider relations initiatives with SummaCare Health Plan to strengthen partnerships.
- Facilitated provider engagement and education programs to improve service delivery.
- Managed provider credentialing processes to uphold quality standards.
- Maintained strong relationships with Payers and Providers for effective collaboration and support.
Provider Relations Representative
Healthstar Inc.
05.1993 - 05.1995
- Managed provider relations and PPO contracting, ensuring effective claim resolution and credentialing.
- Executed rate negotiations for all provider types, including ancillary services, to optimize costs.
- Oversaw contract management processes to maintain compliance and foster positive provider relationships.
Member Services Representative
Aetna Inc.
05.1993 - 05.1995
- Began in Claims and promoted to Member Services.
- Managed Member services for High profile Employer Groups.
Education
BA - International Relations
University of Akron
Akron, OHSkills
- PROVIDER ENGAGEMENT
- CONTRACTING/NEGOTIATIONS
- VALUE BASED AGREEMENTS
- POLICY & PROCEDURE
- PROVIDER EDUCATION
- MEMBER ENGAGEMENT
- QUALITY (HEDIS/STARS/CAHPS/HOS)
- RISK ADJUSTMENT
- 30 YEARS IN HEALTHCARE
- MANAGED CARE
- JOC
- CREDENTIALING
- RELATIONSHIP BUILDING
Affiliations
- President, Athletics Boosters for Norton High School. - 07/24 to Present.
- Mentored, trained, managed lower Level positions at Medical Mutual, Optum, Moda Health, and UHG.
- Member: Healthcare Financial Management Association (HFMA). Involved in Community organizations
Timeline
Program Manager Medicare Stars/Quality
Molina Healthcare (Enterprise)
07.2022 - 09.2025
Sr. Provider Contract Manager
Medical Mutual of Ohio
09.2020 - 07.2022
Network Program Manager
United Health Group – Optum Health
03.2018 - 09.2020
Sr. Provider Network Manager
Anthem Inc.
05.2016 - 02.2018
Sr. Contract Negotiator
Moda Health, Inc
05.2014 - 05.2016
Network Manager
Optum Behavioral Health/UHG
09.2012 - 05.2014
Network Manager, Contracted
United Healthcare
05.2011 - 09.2012
Contract Coordinator/Credentialing
Akron General Network Health Group
11.2000 - 07.2002
PHO Provider Representative
Akron City Health System PHO & SummaCare Health Plan
04.1997 - 11.2000
Provider Relations Representative
Healthstar Inc.
05.1993 - 05.1995
Member Services Representative
Aetna Inc.
05.1993 - 05.1995
BA - International Relations
University of Akron
Similar Profiles
Sarah GlennSarah Glenn
CT & X-ray Technologist at Cleveland Clinic Akron General Health & WellnessCT & X-ray Technologist at Cleveland Clinic Akron General Health & Wellness
Christy D. LouisChristy D. Louis
Nurse Manager at 9100 Neuroscience Unit, Cleveland Clinic Akron General, CCAG, Akron, OhioNurse Manager at 9100 Neuroscience Unit, Cleveland Clinic Akron General, CCAG, Akron, Ohio
Terry FennesseeTerry Fennessee
Medical Supply Courier at Lab Logistics/Akron Childrens Hospital NetworkMedical Supply Courier at Lab Logistics/Akron Childrens Hospital Network
Nicole MoyeNicole Moye
Educator Grades 1, 2, and 4 at King Kamehameha III Elementary SchoolEducator Grades 1, 2, and 4 at King Kamehameha III Elementary School
Rae' Lynn GreeneRae' Lynn Greene
Canvasser at Black OpsCanvasser at Black Ops