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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