SUMMARY:

Motivated and Innovative Health Care Management Professional, with a background in medical claims adjudication, revenue cycle, user acceptance testing, Sales and Marketing. Skilled in building cohesive, productive teams while fostering open communication to drive process improvements.

CAPABILITIES INCLUDE:

• Managed Care
• Medicare Guidelines
• Authorizations & Tapestry UM
• Test Plan & Execution
• Benefits
• Reporting & Analytics
• Quality Assurance
• Revenue Cycle
• Strategic Planning
• Requirement Gathering & Documentation
• Collaboration & Innovation
• Epic Core Certified & Epic AP Proficient, NVT 2016

COMPUTER SKILLS:

• Microsoft Office
• Webstrat
• Quality Center
• Ableton
• Final Cut X
• Encoder Pro
• FormWorks
• SharePoint
• Quick Books
• Epic Certified Tapestry CORE
• Conflict
• KP Academy Health Connect PB
• Epic Proficient Tapestry AP
• Leading Effective Teams
• Facilitative Leadership
• Epic Benefits Engine
• 7 Habits of Highly Effective People

PROFESSIONAL EXPERIENCE:

Confidential

Business Consultant Analyst

Responsibilities:

• Subject Matter Expert (SME) - Authorizations / Tapestry UM
• Managed and trained testing team members SCAL
• Test Planning, Test Execution & Test Closure - SCAL
• Developed, wrote and executed use cases/ test cases
• AP Claims Processing - End to End
• Revenue Cycle
• External Claims and Contracts
• UM Management Referrals/Authorizations
• Elicit, Capture & Document Business Requirements for both current and future state operational specifications and process, which involved leading and participating in cross-functional task forces
• Successfully navigated the necessary tools and systems needed to perform testing and defect management taking into account and ensuring the most critical, significant requirements for testing are addressed as early as possible ensuring that any dependencies (sequence, data, etc.) are accounted for in the testing
• Developed relationships with Upstream and Downstream Business Stakeholders and Partners to solve complex problems in creative and effective ways
• Participated in Root Cause analysis sessions in partnership with operations
• Managed multiple priorities and deliverables concurrently. Successfully met each milestone timely and consistently delivered as promised with integrity to meet program goals.
• Analyzed defect data for trends, Defect resolution and process improvement processes through various management reports.
• Provided on-going status reporting at all levels. Reporting and Analytics for trends in testing, defects that would impact upstream and downstream testing and dependencies.

Confidential, Alta Loma, CA

Bookkeeping/Account Manager

Responsibilities:

• Member retention analytics identifying trends around consumption and analyzing marketing tests and activities to prove effectiveness and ROI.
• Sales and Service - Developed, Implemented and Managed the advertising strategy to bring in new local customers. Personally took part in some of the larger builds, and would regularly assist in day to day calls if needed. Produces regularly scheduled reports around campaign performance and marketing analysis
• Account management - Managed Account receivables and Account payables, was personally responsible for collecting any past due payments as well.

Confidential, Rancho Cucamonga, CA

Supervisor/ Key Holder

Responsibilities:

• Managed the sales floor, General employee,
• Store to store transfers/transfer-outs, handling inventory.
• Promoting new merchandise and sales for the current events, merchandizing new and old Jerseys & other apparel for maximum sales possibility

Confidential, Ontario, CA

Co-Manger/ Coordinator

Responsibilities:

• Hiring and General employee
• Set schedules, sells goals, running the sales floor charting store conversion and plan goals.
• Store to store transfers/transfer-outs, handling inventory for 4 stores cross checking discrepancies.
• Promoted new shoes and sales for the current events, merchandizing new and old shoes for maximum sales possibility, responsible for new store openings and closing down non profitable stores and transferring out all unused merchandise.

Confidential, West Covina, CA

2nd Manger/ Floor Supervisor

Responsibilities:

• Set and maintained sales goals, managing associates on the sales floor making sure they are friendly and informative,
• Handled End of Day deposits and counting out registers,
• Receiving and sending out shipment