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Click here or scroll down to respond to this candidateCandidate's Name
Quality Management Health Promotion ConsultantStreet Address EMAIL AVAILABLE http://LINKEDIN LINK AVAILABLE Miami, FloridaEXPERIENCEHealth Promotion ConsultantElevance Health01/2022 - Present MiamiAnalyze and interpret HEDIS data to identify gaps in care and opportunities for improvement, focusing on enhancing member and provider engagement.Develop and execute strategic health promotion initiatives aimed at improving preventive care, chronic disease management, and overall member health outcomes.Promote health benefits to members, ensuring they are informed and can utilize available resources to improve their health. Work with providers to optimize care delivery practices, ensuring adherence to HEDIS guidelines and standards while fostering stronger engagement.Monitor and report on program outcomes, using data-driven insights to refine and enhance health promotion strategies.Provide education and support to healthcare teams on best practices for HEDIS measure performance and effective member communication. Stay informed on industry trends and regulatory changes impacting HEDIS, health benefits, and quality improvement efforts. Complaints To Medicare Team LeadElevance Health05/2020 - 01/2022 Miami, FloridaLed and mentored a team of 20 professionals, fostering a culture of continuous improvement and high performance.Provided ongoing coaching and feedback on quality audit results, ensuring consistent adherence to quality standards.Developed and implemented KPIs to monitor team performance, using data-driven insights to drive improvements in complaint resolution. Created and maintained SOPs for the Complaint to Medicare process, ensuring compliance and operational efficiency.Collaborated cross-functionally with departments such as Compliance, Quality Assurance, and Customer Service to streamline processes and enhance complaint management.Regularly reported to senior management on team performance, identifying trends, areas for improvement, and success stories. Led process improvement initiatives that enhanced efficiency, quality, and customer satisfaction in Medicare complaint handling. Performance Quality AuditorAnthem08/2014 - 04/2020 MiamiConducted comprehensive audits of Medicare and Medicaid complaint resolutions, ensuring compliance with CMS guidelines and internal quality standards.Provided detailed feedback and actionable insights to complaint management teams to improve resolution accuracy, timeliness, and overall service quality.Played a key role in CMS audit preparation and participation, ensuring that all documentation and processes were audit-ready and aligned with regulatory expectations.Developed and implemented quality assurance processes to monitor and improve the handling of Medicare and Medicaid complaints. Collaborated with cross-functional teams, including Compliance, Quality Assurance, and Operations, to address audit findings and implement corrective actions.Tracked and reported on audit outcomes, identifying trends and areas for ongoing process improvement.Ensured that all audit activities were documented thoroughly and in accordance with regulatory and organizational requirements. SUMMARYProfessional Healthcare Consultant professionalwith over 10 years experience in programmanagement and data analysis. Proven trackrecord leading operational initiatives enterprise- wide to achieve Customer Success and enhanceCustomer Experience. Expertise in initiating,planning, and monitoring program implementationsfor timeliness and compliance. Proficient inanalyzing performance indicators and drivingoperational excellence. Excellent communicator and leader, adept at energizing teams to exceedstandards and streamline workflows. Effective inengaging stakeholders, ensuring regulatorycompliance, and surpassing expectations.LANGUAGESSpanishNativeSKILLSProvider data Microsoft OfficeSalesForceSPS (Strategic Provider System)Tableau PowerBI QNXT/FacetsSOP & KPI CreationPeople ManagementClient ManagementCustomer Experience ServiceNowHealthcare ConsultingPortfolio ManagementClaims Processing Managed CareData Analysis Compliance OversightEDUCATIONAssociates Degree (Pre-Law)Miami Dade College2008 - 2010E q |
