Medical Manager
Resume:
SANTIAGO SANCHEZ PERELES
Orlando, Florida, 32825
**************@*****.***
PROFESSIONAL OBJECTIVE:
My objectives are focus in executing my skills as an administrator or supervisor at its utmost capacity, within a professional setting. Share my experience and contribute to the quality of the working environment for the benefit of all employees and the clients.
OCCUPATIONAL HISTORY & SKILLS:
I am fully skilled as a manager in the medical area.
Proficient in Federal Laws and Regulations, CFR 38.
Microsoft Word, Power Point and Excel.
Completely bilingual.
EDUCATION:
MBA Hospital Administration, Phoenix University, PR (2003)
MBA Accounting & Finance, Interamerican University, PR (2002)
BBA Accounting & Management, Interamerican University, PR (2000)
BBA Business Administration & Computer Science, Interamerican University, PR (2000)
EMPLOYMENT HISTORY:
2013-Present
Auditor
Department of Defense Contract Audit Agency
100 Global Innovation Circle
Orlando, Florida, 32825
Responsabilities
knowledge of both commercial and governmental payers for modeling and analyzing contract proposals.
Variety of Assignments that involved the systematic examination and appraisal of financial records reports
Management Control, policies and practices affecting the financial condition and operations of DOD
Work is performed in an inclusive environment which fosters teamwork, open communication, trust and mutual respect
Prepare routine and adjusting journal entries each month (accruals, revenue recognition, depreciation, etc) Provides timely on-site review of and feedback on the work of Audit Seniors and Staff.
Works with engagement and client personnel to address extremely complex audit and accounting issues, reviews financial reporting for completeness and application of GAAP and ensures that client communications (written and oral) are provided in a timely manner.
Provides the engagement partner responsible for the audit with timely status updates and communicates and involves the partner in the resolution of client service, audit or accounting problems/issues as they arise.
Works to wrap-up audit engagements in a timely and economic manner.
Begins to develop one or more areas of technical specialization (industry related or subject matter) and begins to transition towards service to clients within such areas.
Begins to serve as a technical consultant to other engagements and other offices that have engagement needs within the Managers scope of expertise.
Begins to serve in formal and informal mentoring to less experienced firm employees and as a valued colleague to other managers and senior managers.
Contributes to overall office efficiency by providing feedback on staff performance, participating in initiatives for on-going staff development and developing a teaming culture (through informal social and professional events).
Begins to identify opportunities for expanded services to existing clients (through the development of "trusted advisor status with clients served).
Begins to develop outside relationships with a goal to foster long-term business development opportunities (through membership involvement with professional groups, community service, and personal relationships).
Researching to ensure GAAP compliance. Assist in the development and improvement of accounting processes implementing new ideas to streamline workflow
Assist accounting manager in Review all expenses to ensure proper classification
Assist accounting manager in preparing and reviewing monthly financials
Assist in our annual financial statement audit
Process Improvement/Research Ad Hoc
Provide additional reporting as needed Assist Finance Manager in additional projects
Work with Excel, words and power point for the different audits
Proficient in FAR, CAS and GAAP
2010-2013 Saint Croix CBOC (Clinic based outpatient clinic)
Program Support Assistant
Veterans Administration Hospital
San Juan PR
Responsibilities
Ensure the integrity, accuracy, and timeliness of information sources. Maintains proper documentation of policies and procedures.
Understanding of clinical, operational and financial concepts necessary to manage department information sources.
Provide training and assistance to analysts and customers as necessary.
Improve and innovate department operations and information quality.
Improve and innovate department operations and information quality.
Review information and prevent the dissemination of incorrect or misleading information to customers.
Applies basic understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
Patient Financial Services to enroll veterans to the VA system
knowledge of various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
Revenue Integrity, Charge Auditor, Billing, Coding, Revenue Capture, Audits,
Accomplishments
Reduced the cost of airplane tickets for the veterans and dependents working a contract with the local medical specialist to accept the government rate to treat the veterans in the island.
Open the pharmacy from half time to full time to process all the medications to patients in St. Thomas and St. Croix.
Negotiate a new contract with the land lord to accept the government rate and housekeeping included.
2005 – 2010 COSVI (Life Insurance Cooperative)
Compliance Officer
Responsibilities
Give training and classes of the Patriot Act, Bank Secrecy Act, antifraud law, HIPPA, Medicare, Law 18 2001 state antifraud law.
Quality, including Medical Device Quality System Regulations, Field, Quality System Audits, Document Control and CAPA required
Preparing and enforcing policies internal used of life and medical plan.
Prepared power point presentations and gave trainings of the different laws and regulations every six months.
Strong knowledge of FDA and ISO regulations applicable to medical device industry required
Create, improve and modify processes and document in Quality System SOPs and Work Instructions (INST) while ensuring that the interactions between quality system elements are clearly defined and are easy to understand
Oversees the implementation of quality improvement efforts designed to improve clinical performance and maintain compliance with JCAHO, HIPAA, and other accreditation standards. Responsible for planning and directing quality policies, programs, and initiatives. Relies on extensive experience and judgment to plan and accomplish goals.
The scope of the testing for each of the high risk customers will include the following activities.
The scope of the testing for each of the high risk customers will include the following activities, which will be documented in the Bankers Toolbox BAM application:
Export the last 6 months of transactional history in an Excel file to summarize it by activity types. s, which will be documented in the Bankers Toolbox BAM application:
Strong knowledge and work with the antifraud Act and Bank Secrecy Act as normal functions with the Insurance and Medical Plan
Interprets, develops and implements practices of systems and functions to ensure continuous compliance by regulatory agencies and accrediting bodies (JCAHO, AOA, CMS, NCQA, AHCA, FMQA, AHS Corporate Compliance
Accomplishments
Help to resolve Medicare fraud of two million dollars from a medical group.
Reduced the cost of presentations and trainings using the internet for the offices out of the main city.
Enroll the company in the Anti Fraud Compliance Officer Association.
2001 – 2005 Monitor for the Veteran’s Advocate Office
Veterans Home (Nursing Home)
Juana Diaz PR
Responsibilities
Administered and coordinated project activities to ensure administration efficiency and compliance with federal laws and regulations applicable to the Veterans Nursing Home and Skill Nursing Facility.
Revise and supervised the contractor’s operation for a two hundred and forty bets on a daily basis to ensure the continuity of the operations is maintained to the highest standards required by local, state and federal agencies.
Supervised the Quality Control Program and implement any changes required.
Revised and audit all financial statement from the private contractors to ensure compliance with the facility administration contract of services.
Work with human resources with the benefits for retirement and medical insurance and outsourcing benefits.
Ensure that the contractor follow all the EEO guidelines with special emphasis on Veterans preferences under equal qualifications.
Supervised all repairs and alterations made to the fifteen million dollars’ facility, kept a watchful eye on all equipment, property and machinery in order to be maintained in optimum conditions.
Develop, revised and implement company policies and contract standards.
Ensures that the activities of the medical staff organization meet all internal requirements (bylaws, rules and regulations, policies and procedures) while ensuring compliance with external accreditation standards, state and federal laws and Medicare Conditions of Participation.
Health care Management for the Skill Nursing Facility for the service of the patients.
Ensures provision of quality services by maintaining appropriate resources, staffing levels, competency of staff, maintenance and performance of equipment, instrumentation calibration.
Patient Financial Service, Financial Advocate Manager
Physical space, and training and education of staff.
Ensures patient assessment and therapy is appropriate, accurate and patient specific.
Ensures documentation of care is timely, accurate, Patient Financial Service, Financial Advocate Manager and complete.
Continually applies the principles of continuous quality improvement through monitoring, measuring, assessing, and reporting quality indicators and trends to improve patient outcomes or prevent patient injury.
Demonstrates responsibility and accountability to ensure that the department is compliance with all legal, regulatory and accrediting agencies, i.e., JCAHO requirements. Ensures department documents IP/OP changes and reports billing in accordance with HCA Guidelines.
Ensures department contributes to continuity of care through demonstrated use of interdisciplinary team approach to patient care.
Collaborates, shares pertinent patient information with physicians, patients, and other appropriate members of the healthcare team regarding patient progress and treatment.
Demonstrates knowledge of the occurrence reporting system and reports trends in occurrences to staff quarterly. This information is used to improve patient safety.
Addresses patient safety in the Performance Improvement Plan.
Business Analyst for the Nursing Home
Work actively with Microsoft Excel, Power Point, words for all activities of the Nursing Home
Accomplishments
Implement and administered the Skill Nursing Facility in accordance with the Nursing Home.
Work in coordination with the State Government to implement and incentive for the payment of the Nursing Home and Skill Nursing facility.
Contract with outsourcing contractor for the service of the Skill Nursing Facility.
Implement new regulations in accordance with HIPPA law, and VA regulation, State regulation.
Brought the number of patients to the maximum with a waiting list of average two months.
Made a routine formal presentation and recommendations to senior management and high ranking officials, regardless strategic planning, policy development, employment, medical- legal affairs, and other personal issues.
Implementation of the electronic medical record at the facility before private and public hospitals.
Integrate the facility to the join commission of medical facilities.
Personal goal been appointed sub director of the Veterans Advocate State office.
2000 – 2001 Telehealth
Program Support Assistant
Veterans Administration Hospital
San Juan,
Responsibilities
In charge of the administration of the first Telehealth program in Puerto Rico for Diabetes and High Blood Pressure for veterans with difficult access to the main Hospital
Monitoring of the budget as a separate entity of the main Hospital for vehicles and recruitment of personnel
Accomplishments
Extend the program in rural areas of difficult access.
Increased the number of monitors to Veterans of difficult access.
Recruitment of new personnel.
Inclusions of the program in the routine services in the medical center.
1996 – 2000 Record Room
File Clerks
Veterans Administration Hospital
Responsibilities
File medical documents in the medical personal file of one and each one of the patient.
Accountability and auditing of medical records.
Accomplishments
Best organize area of medical records awards for two consecutive years.
1984-1996 US ARMY
FT Benning, Ga
2
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