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Skills

  • Job control language (JCL)
  • Corrective action implementation
  • Automated data validation systems
  • Database administration
  • Agile methodology
  • Data Quality Monitoring
  • RFI Scanners
  • CCTV
  • Planning and coordination
  • Apache Tomcat

Work Experiences

  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Collaborated with payers.
  • Actively monitored data quality metrics.
  • Achieved a 31% improvement in network adequacy.
  • Achieved a 77% decrease in manual data entry tasks.
  • Saved money by developing functional solutions to system problems.
  • Achieved President's Club for highest data compliance rate.
  • Collaborated with state authorities and payers to ensure compliance with provider network adequacy standards and prevent regulatory fines.
  • Answered 15 phone calls per one year to assist customers.
  • Audited systematic inaccuracies that affected provider payment schedules, leading to a 61% recovery of improperly categorized payments.

Summaries

  • Motivating leader who has built and managed metric teams in the past.
  • Strategic thinker with expertise in quality assurance.
  • Collaborative and team-oriented, with excellent oral and written communication skills, as well as complex problem-solving and decision-making skills.
  • Budget management in process settings and data analysis in workflow optimization settings.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Achieved a 45% improvement in claims processing accuracy.
  • Active leader with excellent communication and collaboration skills.
  • Workday and Asana experts with exceptional interpersonal skills.
  • Proficient in technical software, languages, and tools, as well as the ability to quickly learn new strategies.
  • Framework, method, and initiative are among the development languages in which I am proficient.

Accomplishments

  • Created a report detailing provider data quality improvements, which led to better alignment with CPA compliance.
  • Championed and implemented data governance protocols impacting over 16 provider records, resulting in improved compliance with industry standards.
  • Consistently managed provider inquiries and credentialing issues, maintaining an overall satisfaction score above 58%.
  • Investigated and resolved data integration issues with health plans, safeguarding over $17 in provider payments annually.
  • Engaged with third-party vendors to ensure accurate data transmission, reducing external errors by 67%.
  • Developed custom reports to track provider data changes, resulting in greater data transparency and audit readiness.
  • Cross-referenced databases with payer systems, identifying and solving 17 mismatches, fostering seamless provider billing processes.
  • Reduced system lag time by 18% through process optimization, enhancing provider database search speeds.
  • Provided insights for optimizing existing provider data management workflows, resulting in a 72% faster data processing time.
  • Resolved escalated provider credentialing and data issues within an average turnaround time of 2 days.

Affiliations

  • Attendee, Vendor Data Management Conference, 2023
  • Certified Healthcare Quality Professional (CHQP), standard
  • Founder, Provider Data Accuracy Task Force, Harbor & Co.
  • Volunteer, Healthcare Data Quality Improvement Initiative, 2018
  • Participant, Cross-functional Healthcare Collaboration Summit, 2015
  • Speaker, Training Workshop on Data Extraction in Healthcare, 2019
  • Member, Healthcare Data Resources Working Group, Vantage
  • Certified Provider Data Technician (CPDT), initiative
  • Active Member, Healthcare Quality Improvement Committee, Austin
  • Completed SQL for Health Data Analytics Course, 2021, Vantage

Certifications

  • EpicCare Data Certification 2019
  • Certified Information Systems Auditor (CISA)
  • Master of Provider Data Leadership (MPDL)
  • Microsoft Office Specialist (MOS)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Azure Data Fundamentals Certification
  • First Aid/CPR
  • Six Sigma Black Belt Certification - Summit Group
  • Certified Public Accountant (CPA)
  • Advanced Credentialing Specialist (ACS) Certification

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