Quality Control Assurance
Resume:
KAREN NIEVES
***** ******** ******** **., ****, TX 77494
*******@*****.***
SUMMARY
Highly qualified professional with sixteen (16) years of combined experience
in Quality Assurance, Manufacturing Operations, and Medical Insurance
Management Medicare Advantage. Comprehensive knowledge of Quality
Management System and ISO standards. Excellent management and
communication skills, marked by ability to encourage and motivate staff
through straightforward, honest interaction and personnel development.
Motivated and dedicated employee devoted to ensuring highest standards of
quality and service. Fully bilingual in Spanish and English.
SKILLS
Administration and Management Computers and Electronics
Customer and Personal Service Persuasion
Critical Thinking Service Orientation
Monitoring Systems Analysis
Complex Problem Solving Education and Training
Judgment and Decision Making Quality Control Analysis
Time Management Negotiation
EXPERIENCE
2004-2013 Provider Relations Representative, MSO of Puerto Rico, MMM Holdings, PMC
Medicare Choice
Educate Providers on products, policies and procedures.
Manage the collection and follow-up of information for all aspects of
provider credentialing and physician office review.
Continuously monitor implementation of new and/or revised contracts and
contract checklists.
Manage the corporate interdependencies to assure timely resolution of
complex provider issues to strengthen partnerships.
Assist with the distribution of provider communications and ensure
understanding at face to face meetings.
Actively participate in POST and provider technology training as needed
Provide project management responsibilities as needed which may include
coordination of projects to meet regional, divisional and corporate
initiatives.
Assist in the design and implementation of solutions to Provider issues and
problems.
Serve as a resource for providers and their staff regarding medical
management initiatives, electronic technology issues, new programs and
products.
Provide support in contract compliance and audit initiatives.
Make daily reports of provider visits.
1994-2001 Outgoing Quality Auditor, Intel Puerto Rico Ltd.
Examine computer mother boards’ assembly department.
Perform quality control inspections.
Plan and accomplished goals set forth by Quality.
Communicate with and assist 2nd and 3rd party inspectors.
Encourage continuous improvement of processes.
Track and manage Non-conformance Reports and maintenance of all quality
records.
Document inspection data clearly, accurately and honestly on required
forms
Complete final inspection prior to shipping.
EDUCATION
2004 Bachelor of Science: Respiratory Therapy
Universidad Metropolitana-San Juan, P.R.
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