Anita Fluharty Leal Email & Phone Number

Dallas, Texas, United States

Providing consultant/advisory services for health systems related to operations, strategy, and policy for Medicare Advantage, TRICARE, and Health Insurance Exchange product lines.

Irving, Tx

In charge of creating and serving as a senior executive of CHRISTUS Health Plan, growing plan to nearly 50,000 members; monitored sales forecasts and projected financial planning to achieve revenue goals:● Developed Plan from Concept to Operational Reality● Expanded Plan to Three States and Multiple Regulated Products● Successfully Grew Plan to $350M in Annual Revenue Contributions:Devised new promotional approaches to boost membership and market penetration, enhancing engagement, and driving growth.Built and strengthened productive and valuable industry partnerships to drive collaboration and revenue stream development.Worked closely with organizational leadership, including the board of directors, to strategically affect the direction of operations, resulted in reducing associate turnover to under 6%.Spearheaded business development initiatives to build a plan from scratch to operational reality with the health system to align with the organization’s strategy and core competencies.Evaluated service contracts and collaborated with legal counsel on negotiated improvements to improve administrative costs 8%.Instituted formal operating procedures and enforced adherence to policies and regulations that impacted bottom-line by mitigating fines and penalties from regulatory audits.Provided leadership to create an organizational plan with clear roles and responsibilities to enhance processes while ensuring quality and regulatory compliance, resulting in a positive Medicare Advantage program audit without administrative penalties.Promoted the organization's mission through successful community outreach and marketing strategies, including developing and opening a community center. This was developed using community benefit dollars serving 225,000 members in Smith County.Orchestrated positive media coverage and stakeholder relations as the public face of the health plan. Media coverage was in every market served over 10 years.

Houston, Tx

Negotiated and analyzed hospital and provider contracts for value. Educated revenue cycle staff on the terms of the agreements. Collaborated with teams on questions regarding over or underpayments and tracked and analyzed reports to determine areas for improvement.Contributions:Directly responsible for all managed Medicaid contracting for the health system.Served as a liaison with 12 payors, resulting in positive relationships.

Houston, Tx

Oversaw all health plan contracting, credentialing, and provider relations, ensuring compliance with state insurance rules:● Aided in Establishing the Health Plan's Government Programs in Texas● Transitioned CHIP product from Stand-Alone Plan into an Integrated Health Company● Key Contributor of the Transition from UTMB Healthcare Systems Contributions:Led team efficiency by strategically delegating daily activities, monitoring output, and rewarding positive contributions; as a result, these efforts were successfully able to re-contract the network for the transition from UTMB Healthcare Systems.Directed team of six associates with resolving provider issues, focusing on positive outcomes that created provider loyalty and alignment, resulting in minimal provider turnover.

Galveston, Tx

Dynamic nine-year healthcare career with UTMB Healthcare Systems highlighted by increasingly responsible leadership and management roles from credentialing to contracting to operations:● Successfully Achieved NCQA Certification with 100% Compliance● Passed Texas Department of Insurance Audits with Greater Than 95% Compliance● Engaged with 3,000+ Providers and Stakeholders Across a Twenty-County Service AreaContributions:Worked with 3,000+ providers and stakeholders across a 20-county service area to understand contractual requirements and provide exceptional service.Key contributor to the Managed Medicaid Bid Award for the network adequacy and credentialing responses.

Galveston, Tx