Leslie Holliday

Email: abqd71@r.postjobfree.com

Address: **** *. ******** ******

City: Pasadena

State: CA

Zip: 91104

Country: USA

Phone: 818-***-****

Skill Level: Management

Salary Range: $70,000

Willing to Relocate

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

LESLIE HOLLIDAY

818-***-**** Pasadena, CA abqd71@r.postjobfree.com

PROFESSIONAL SUMMARY

Proven success within the managed care industry, directing independent physician, medical & insurance networks / groups. Record of delivering quantifiable results through; client relationship development, daily interaction, financial analysis, creative problem solving, disciplined execution and performance management.

Managed Care Professional / Healthcare Network Management / Provider Network Management

Physician Recruitment / Physician Contract Negotiation

PROFESSIONAL DUTIES & RESPONSIBILTIES

Provider Network Director -

Responsible of overall financial management of assigned Healthcare Provider Networks

Continuous financial analysis and performance reviews to implement improvements & optimize financial performance

Interfacing with multiple departments[internal/external]; contracting( provider & health plan), client care, claims & capitation, eligibility, marketing

Direction of new IPA development & expansion

Monitoring of all Federal & State regulatory requirements ensuring up to date compliance

Administration of policies and procedures for participating providers

Senior Network Account Manager -

Insure provider compliance with contractual responsibilities

Handle `issue resolution` for high profile plan sponsors

Coordination with `Sales & Marketing` to identify provider education opportunities

Conduct member education events via Health Fairs on Aetna products and plan designs

Access sensitive client information to meet regulatory and control requirements

Review and approve monthly reports for accuracy

Facilitate operational meetings with clients

Resolve provider complaints

Sr. Contract Negotiator -

Negotiation of multi-year provider contracts

Contract maintenance of assigned providers

Claim -issue- resolution

Supervision of provider network expansion projects

Design and implementation of a highly effective provider database

Staff Coordination during client and provider education projects

Communication of operations & assignments to senior management

Physician Recruiter -

Identification & recruitment of non-participating physicians, IPA`s & medical groups

Management of new physician expectations

PROFESSIONAL EXPERIENCE

TENET- CMS CAP Systems, Encino, Ca 2010 - 2012

~Director Provider Networks

AETNA Inc., Woodland Hills, Ca. 2005 - 2010

[formerly -Prudential Health Plan Inc .]

~Senior Network Account Manager

~Contract Negotiator

~Physician Recruiter

PRUDENTIAL HEALTH PLAN Inc., Canoga Park, Ca. 1987 - 2005

~Underwriter

~Claims Examiner

RELATED EXPERIENCE

Underwriting - [2 yrs]

Assessed the risk of enrolling applicants for group health coverage policies

Claims Examination - [3 yrs]

Examined claims and other medical records to determine eligible benefits

EDUCATION

California State University, San Diego

-Liberal Arts

Salary history and referral information available upon request

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