Philip May
(262) 389-2259
philipmay@leadershipmentor4hire.com
PROFESSIONAL PROFILE
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Skilled in building strong outcomes oriented teams through trust, respect, and honesty.
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Managed Care and insurance professional with extensive sales, provider contracting, and network
development skills, including contract preparation and implementation, financial analysis and rate
proposal development.
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Experienced in managing Medicaid, Medicare, CHIP, Commercial, Marketplace, and ACO networks
meeting all CMS (Medicare, Medicaid) and State regulations.
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Experienced in contracting Health Plans for TPA services including Risk, Risk Share, and ASO models.
Consultative selling
Relationship management
Provider contracting skills
Provider relations
Contract preparation and implementation
Provider network analysis
Financial analysis/Modeling
Cost of care/quality Analysis
Rate proposal development
Network development
PROFESSIONAL EXPERIENCE
DentaQuest, Mequon, WI
Network Development Supervisor
December 2008 – October 2014
Achievements:
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Contracted 4,000 providers in Texas in eight months, winning largest contract to-date.
Contracted winning Medicaid provider networks nationally including: Kentucky, Kansas,
Mississippi, and others.
Transitioned receipt of credentialing applications from 0% electronic to 40% in four months.
Responsibilities:
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Supervised, mentored, and performance managed team of 20 network development recruiters,
care coordination specialists, and contractors.
Presented network plans and progress updates to senior leadership HMO and State clients,
generating confidence and superior customer service.
Met budget targets every year of a $600,000 annual budget.
Developed network development strategies, growing membership from 12M-20M in six years.
Negotiated complex contracts with Hospitals and universities for Medicare and Medicaid.
Gained support from Primary Care Associations and other stakeholders securing new business.
Evaluated network and cost using GEO Reports, provider composition, utilization, provider-tomember ratio, and, member assignment, and quality indicators. Saved $500,000 in Missouri.
Hosted provider orientation sessions, and participated in client/provider facing meetings.
Implemented a train the trainer program where Provider Relations team trained providers
resulting 40% adoption of new online credentialing application.
Maintained CEO facing Gantt report on all network management and recruitment initiatives
keeping all items in GREEN 99% of the time.
Philip May • (262) 389-2259• philipmay@leadershipmentor4hire.com
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In a project portfolio manager role monitored and managed 30+ new business implementations
annually including contract installation, fee schedule set-up, provider loads, and configuration.
Personally led sales and negotiation training sessions and brought in Dale Carnegie.
Oversaw client contract audit responses with average scores of 97% where the goal was 95%.
DentaQuest, Mequon, WI
Sales Executive
February 2007 – December 2008
Achievements:
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Sold first multi-state dental and vision Medicare TPA ASO contract (first vision TPA LOB client)
generating $250,000 in annual revenue.
Led RFP response winning Medicaid dental carve-out contract for District of Columbia generating
$800,000 in annual revenue.
Responsibilities:
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Managed 18 month sales cycle selling to HMO C-Level executives full service Dental Benefits
Administration through 70-100 contacts and 3 in-person meetings monthly.
Managed average 3 years sales cycle conditioning managed care Medicaid states for dental
carve-out opportunities. By coordinating with contract lobbyists to meet with key legislators for a
dental carve-out obtaining first state contract in a 12 month time period.
Presented bid requests to underwriting and worked with them to solicit winning prices.
For RFP opportunities presented overview of RFP to department executives, illustrating
opportunity and soliciting departmental responses for winning RFP’s.
Transitioned sales to Client Services and Project Management Office team.
Wrote Annual Sales Plan as part of the enterprise Strategic Operating Plan.
Coordinated and collaborated on Request for Proposal responses with Marketing.
DentaQuest, Mequon, WI
Provider Network Recruiter (Connecticut Market)
December 2004 – January 2007
Achievements:
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Contracted Yale New Haven Hospital System into Connecticut Medicaid network.
Replaced high cost private practice providers by negotiating lower cost provider agreements.
Negotiated high cost sole proprietor provider agreements downward.
Responsibilities:
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Owned Connecticut provider network adequacy and closed all network deficiencies.
Negotiated with a practice to open an office in a deficient county within 6 months.
Provider Relations via phone queue, resolving contract, claims, and authorization issues for
providers in 18 states.
Followed-up on all missing credentialing/contract documentation for my providers.
EDUCATION
Marquette University, Milwaukee, WI
Concordia University Wisconsin, Mequon, WI
Graduate Certificate, Leadership Studies
Bachelors of Science, Marketing and Management