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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Noche Clara Dr.Del Valle, TX Street Address
(M) PHONE NUMBER AVAILABLEEMAIL AVAILABLEProfessional SummaryI am a self-directed, motivated individual who can facilitate the completion of both personal and professional goals in an expedient manner. My objective is to continue expanding my knowledge, skills and develop my instructional strategies.Summary of Qualifications HEDIS Metrics/HEDIS performance Program/Project Manager Leadership Value-Based Contracting Modelso Implementationo Managemento Evaluations Healthcare Improvement Managed Care Quality & Process Improvement Population Health Management Provider Education/Engagement Health Care Reimbursement Strategic Thinking Digital Communications Case Management Medicare/Medicaid Bilingual (Spanish & English) CLSSYBWork HistoryAccountant V January 2024 to CurrentHealth and Human Services Commission (HHSC) Austin, TX Performs highly complex (senior level) accounting work Develop and train accountants within the HHSC Accounting Division and peripheral accounting areas as they onboard Assist in the development and coordination of all centralized training deliverables, CAPPS upgrade training, including training on accounting systems, procedures, and controls Work under limited supervision, with considerable latitude for the use of initiative and independent judgmentSupervisor January 2022 to December 2023Superior Healthplan Austin, TX Oversee day to day responsibilities for the department including but not limited to production, adherence, and quality assurance Onboard and train new hires for a period of three weeks to prepare agents once they are working independently Schedule and conduct interviews to recruit best talent Work with programmers and analysts to ensure databases are working efficiently to adhere to our standard operating procedures Provide coaching opportunities for all underperforming agents by meeting weekly/monthly and assist agents to improve gradually Initiate and deliver disciplinary action plans and/or terminating individuals whose performance did not improve within the allocated time HR recommended Created reports which displayed high level data to share with leadership and propose ideas in which to improve already in place proceduresProcess Improvement Specialist - August 2020 to January 2022 Superior Healthplan - Austin, TX Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions Develop proficiency in tools and value-based performance (VBP) and educate providers on the use of tools and interpretation of data Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetingsProvider Data Coordinator II - February 2018 to August 2020 Superior Healthplan - Austin, TX Create payment grids to calculate quarterly and year end payments Communicate with corporate regularly to exchange reports containing financial information Served as the primary contact for different APM providers to answer questions or resolve issues Managed multiple electronic mailboxes that allowed providers to communicate any concerns Generated manual check requests for over 60 providers to execute payments and meet contractual agreements as well as state deliverables Provided quarterly reports containing physician demographics enrolled in APM programs along with the total payouts that were earned in previous payment periods Provider Practice Coordinator - April 2016 to February 2018 Superior Healthplan - Austin, TX Interacted with office staff to promote doctor visits and reduce ER visits Increased THSteps completed visits by scheduling appointments for members by eliminating barriers such as transportation, and/or misinformation regarding practice hours of operations Provided monthly reports to Directors which demonstrated an increase in compliance rates for Carousel Pediatrics month after month Implemented policies and procedures that pertained to the Provider Practice Coordinator Educated both non-clinical and clinical staff on how to improve processes and achieve successful appointments in the futureMember Advocate September 2015 to April 2016Superior Healthplan - Austin, TX Respond to Member Complaints and formal grievances to identify potential access barriers and resolve as indicated per company policy while meeting state contractual agreements Investigate and resolve access and cultural sensitivity issues identified by member services, state staff, providers, advocacy organizations and recipients Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of members Update and revise educational materials as appropriate in both English and Spanish Serve as primary contact to PCPs, Specialists, and case managers Maintain confidentially per HIPAA guidelinesEnrollment Processor June 2013 to September 2015 Superior Healthplan Austin, TX Responsible for maintaining membership records up to date with the most current information provided by the State Respond to internal and external entities within 48 hours Upload files on to SHP internal databases for all Texas Medicaid product lines Resolve issues on enrollment files Complete tasks in a timely manner to ensure member coverage Program Technician 2 February 2011 to May 2013Maximus Austin, TX Process applications for recipients seeking government assistance and make decisions based on the state income (FPIL) policy Review documents to ensure qualifications and fraudulent information Met quota and standards set by my superiorsEnrollment Broker July 2008 to January 2011Maximus Austin, TX Answered 60+ calls per day Solved problems while deescalating irate callers Kept up to date with state process and procedures to better assist members EducationBachelor of Science in Social Psychology: August 2017-May 2022 Park University - Parkville, MO |
