Customer Service Project Manager
Resume:
JOEL CRUZ
Upland, CA *****
Cell: 909-***-****
OBJECTIVE - Seeking a position that will utilize my skills allowing me to advance to a position of broader
responsibilities in Healthcare.
October 2007 - Present (Kaiser Permanente)
MEDICAL IMAGING IMPLEMENTATION PROJECT MANAGER
Leads and provides expert technical leadership to highly visible, sensitive and multi faceted
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projects. Sets strategic direction of projects. Develops project plans which identify key issues,
problems, approaches, performance metrics and resources required. Designs processes to
address identified problems. Establishes team membership and negotiates time commitments
and resource allocation. Provides staff leadership to multi disciplinary teams, as well as manages
work of outside consultants. Motivates team members and facilitates team meetings. Acts as
liaison, problem solver, and facilitator. Cultivates and reinforces appropriate group values, norms,
and behaviors. Provides guidance to team on performance and productivity issues. Designs
research plans for data gathering and analysis. Actively participates or may lead in analyzing data
and developing recommendations and action plans. Accountable for the development of project
documentation for senior executives and other key clients to facilitate sharing of project outcomes
and best practices. Plans and facilitates meetings. Makes formal presentations to various senior
level audiences. Establishes procedures regarding implementation of project outcome. Assesses
project impact on workforce. Establishes effective professional business relationships with all
levels of management. Instructs and educates on all aspects of project.
Leads Digital Imaging projects in the Fontana Service Area (which includes two Medical
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Centers and nine clinics).
Opened New Fontana Hospital and Ontario Hospital.
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Projects include GenRad (MR, CT, Nuclear Medicine), Mammography, Fluoroscopy, Orthoview,
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Clickview, CVIS (which is a Cardiology Information System), RadWhere (voice recognition
dictation application), and Visible Light.
March 2006 - October 2007 (Kaiser Permanente)
SENIOR ANALYST CLINICAL SYSTEMS
Train physicians on IMIS applications (CT-MRI-Ultrasounds-CR, DRS, Penrad).
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Train users on EPIC (Cadence, OPAS, etc.).
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Collects data and provides analyses for a broad array of issues across disciplines and
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functional areas.
Develops project plans which identify key issues, problems, approaches, performance metrics
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and resources required.
April 2004 - 2006 (Kaiser Permanente)
CONFIGURATION ANALYST
Gathers and prepares analysis based on information from internal and external resources.
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Creates and maintains detailed benefit services and benefit plans in the Foundation System
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(HMO, POS, PPO, and Indemnity).
Runs Business Objects and/or Access queries to conduct detailed benefit and plan analysis.
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Validates system functionality after benefits are entered in applications.
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Coder and Contact for AOMS (Authorized Outside Medical Service).
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Trouble-shoot AOMS issues and handle System Impacts.
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Troubleshoots, investigates, analyzes, and solves configuration-related problems.
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Trouble-shoot hotline and Movaris issues (Sales, Claims, Product Development, etc.)
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1996-2004 (PacifiCare)
BUSINESS ANALYST
Review medical benefit policies and state mandates to perform analytical research for system
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implementation and configuration process.
Manage projects for PPO, POS, Indemnity, and Senior Supplement products (Meet deliverable
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timelines).
Configure claims processing application.
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Perform tests to validate data accuracy prior to product management and compliance review.
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Resource to trouble-shoot and consult application problems relating to benefit plans in the
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computer system.
Setup employer group and eligibility data.
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Coordinate with Compliance, Regulatory, Product Development, Provider Contracting,
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Membership Accounting and Sales divisions to ensure quality and accuracy in plan designs.
Develop auto adjudication enhancements
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Responsible for determining CPT, HCPCS, ICD9, and Revenue codes systematic structure in
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relation to building benefit plan logic.
Train.
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CLAIMS EXAMINER II
Process medical claims in an accurate and timely manner.
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Investigate and resolve customer service issues.
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Assist in training of examiners.
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Maintain superior ratings in quality and production standards.
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Audit.
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1989-1996 (TRAVELERS INSURANCE)
SENIOR CLAIMS EXAMINER
Process medical claims in an accurate and timely manner.
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Accounting (Over and Underpayments).
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Handle incoming calls from providers and members.
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Audit claims.
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Assist in training with customer service reps and examiners.
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Maintain superior ratings in quality and production for both customer service and claims
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processing.
Front End Keying Lead.
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1996 (ALL TEMPORARIES, INC)
CLAIMS EXAMINER II
Reported to various insurance companies to fulfill temporary needs for medical examiners.
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