Quality Assurance Manager
Resume:
Jacqueline Almodovar
*******************@*****.***
NY, NY 10018
Objective: Seeking a challenging and progressive position within a Organization that requires the best of individuals.
Qualifications: Effectively: Handle multiple tasks in any fast pace environment. Strive to continuously improve service by
applying new ideas to increase productivity while demonstrating ability to meet deadlines.
Experience:
1/07 – 11/09: MultiPlan Inc, New York, NY
Provider Quality Assurance Analyst:
• Responsible for auditing work completed thru the Practitioner Operations department and
delivered to QA Team Leader on weekly basis
• Developed and maintained weekly documentation of all audit spreadsheet results
(Corrections and Errors issues)
• Analyzed & Ensured complete accuracy on current updates submitted by
group/practitioner
• Reviewed database & implemented any corrective action when necessary
(Adding/changing/terming)
• Identified issue and determined appropriate course of action
• Developed and maintained collaborative relationship with Registrar & DPM
departments (Reported and resolved data maintenance issues)
• Participated & Conducted in bi-weekly staff meetings to ensure all new/revised
upgrading policies, procedures & system changes are being implemented correctly
• Presented bi-weekly examples of maintenance/data issues to alert colleagues and
improve accuracy to resolve and eliminate further maintenance/data issue.
• Determined and deleted duplicate records in network
• Recommended and assisted in enhancements to departmental systems and procedures
• Performed & completed various other duties as assigned by department director
• Identified incorrect scanned image batches
• Ensured the quality, integrity of our internal and external provider network data
system.
• Provided customers priority and efficiency when making any decision and taking
action
• Organized and submitted updates/applications received thru fax/email to appropriate
departments
• Provided support to other team members as needed
• Trained new employees on department policies, procedures & database
• Continually strived to provide credentialing expertise to monitor accuracy of data and
processes
12/03 – 1/07 Credentialing Specialist:
• Generated daily reports on application status to assist management in accurate status of
inventory
• Credential Verification Information – (CVI) - Prepared new applications submissions
(Reviewed and identified problems in applications and made necessary corrections or
escalated problems to appropriate individual)
1. Communicated daily & managed strong working relationships with various
internal/external sources to verify/retrieve missing documentations
(Network Development, Credentialing Coordinator, Practitioners)
2. Handle high volume of issues by telephone, fax, in writing and/or via email.
3. Work directly with Providers, Negotiators & Managers to effectively resolve
provider issues & ensure complete accuracy within a timely & effective manner
4. Maintained all physician profiles and ensure all record are kept confidential
5. Approved & Disapproved status of an applicant
6. Returned all disapproved applicant and informed Practitioners/Credentialing
coordinator of disapproval decision - Notified practitioners of standard appeal
process.
7. Handled and returned all withdraw applications
• Conducted verifications on License & National Practitioner Data Bank for individual
practitioners
• Ensure professional liability insurance coverage is current & valid in practicing state
• Re-credentialed existing providers in Network
• Determined if applicant is a member of group or an Individual applicant
• Perform weekly preparations for returning incomplete applications
• Generated and prepare large quantity of out going request mail
• Identify and corrected undeliverable request mail
• Maintained 3 separate data base file system in conjunction with each other
• Provided training and leadership to encourage, motivate and evaluated the
performance of new employees
• Performed Quality Assurance completion on newly credentialed applications
• Communicated various ideas to Manager/Director to help department perform effectively
while company’s policy and procedure are revised due to acquisition and integrations.
• Handled & completed multiple special projects as assigned by the Manager/Director .
10/99 - 6/02 Tully Construction Company, Queens, NY
Accounts Payable:
• Maintained and organized files
• Monitor, prepared, posted all invoices
• Handled high volume of phone calls
• Managed and maintained all A/P records, reports and files
• Approval/disapproval on payments of invoices
9/96 – 6/98 Monroe College Bronx, NY (Major: Accounting)
References: Available Upon Request.
PC Skills: Microsoft Office 2003 including Outlook, Word and Excel, MultiPlan Provider System,
Practitioner Recruiting Data Base, Access Data Base, Reqlog, & Timberland
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