Budget Analyst Compliance

PROFILE

Extensive knowledge, background and experience in the quality and compliance related to health care, finance, legal system, and comprehensive data analytics in both government and private entities.

Utilization of applications such as Power BI, Power Pivot, and advanced Excel formula to build data management and data visualization on dashboards for monitoring, reviewing, and analyzing performance measurements and operational metrics.

Application of lean sigma concepts and statistical analysis for resolution of conflicts and providing quality service for client solutions.

Collaboration and support the management team by performing continual improvement process for different projects to enhance the workflow of business process in effective manner for profit improvements.

Management of the different programs’ financial data and provide recommendations for health status of the organizations.

CORE QUALIFICATIONS

Quality and Compliance Management

Financial and Healthcare Reporting

Lean Sigma While Belt Certification

Lean Sigma Green Belt Training with project.

Project Management

Health Care Legal Grievance and Claim

Budget and Accounting

Medi-Cal Billing and Claim (DRG, EHRs, and other Medi-Cal claims)

Pricing and Calculation methodology for claims

SYSTEM AND APPLICATIONS:

Excel (Power Query, Pivot Table, and complex formula: XLOOKUP, SUMIFS, MATCH.)

Microsoft (Word, PowerPoint, Outlook, OneDrive, OneNote, and Publish)

Business Intelligent (SAP, Hyperion, Power BI, Tableau and SAS)

CALSTAR Online Reporting Environment

Human Resources Information System (HRIS)

Adobe Acrobat Pro

Health Care Appeals Risk and Tracking System (HCART)

Electronic Health Records System (EHRS)

Customer Relationship Management (CRM)

Strategic Offender Management System (SOMS)

Disability and Effective Communication System (DEC)

CAMMIS System

PROFESSIONAL EXPERIENCE

Gainwell Technologies/DXC Technology Company October 2019 – December 2021

Professional Quality Program Compliance Analyst II

Strategies Result: Designed and development business process to measure process health and performance with the intent of detecting and resolving problems for continuous improvement for provider billing claim process; relation to cost and expense reduction for business areas throughout the years to achieve margin expansion target and to drive the profit improvement and efficiency for Medi-Cal billing and claim services.

Developed, facilitated, and deployed key goals with starting a new contract to achieve the operational goals and metric requirements for the organization.

Supervised, managed and established standardized policies, processes, audit tools and resources such as checklists, templates, data trends, and reports.

Performed an audit by conducting random sampling for validation of claim processing requirements and provided recommendations for any deviations after a comprehensive root cause analysis for identified issues.

Collaborated with senior management, supervisors, and peers across the organization for continual improvement process for different projects.

Possessed extensive knowledge of Medi-Cal policies and procedures such as pricing methodologies, ICD9-ICD10, DRG, HCPCS coding, Ras, and EOBs for validation of claims on completeness and accuracy for Medi-Cal billing and claims.

California Correctional Health Care Services December 2016 – October 2019

Senior Health Care Grievance Coordinator/ Quality Program Compliance Support

Strategies Result: Supported the healthcare administrative and clinical leadership teams by resolving and managing the legal conflicts between the patients and providers by developing management reports with trending analysis and issues from the dashboards and different database systems.

Lead of the Health Care Grievance Office for patient’s claims

Developed monthly management reports, presented the systemic trends and issues in related to timeliness, and quality of response along with recommendations for improvement.

Researched and analyzed complex and sensitive health care information through healthcare electronic record systems.

Collected data and prepared a response to legal appeals and claims regarding patient’s outcomes.

Facilitated leadership team meetings to address the patient’s grievance to improve health care delivery, mitigate risks, and litigation on services for audits pertaining to OIG criteria.

Created ad hoc report and generated a comprehensive analysis on the data.

Applied critical thinking and statistical analyses to meet the performance metrics.

Designed a new grievance process and provided trainings for all staff.

California Department of Health Care Services (DHCS), Sacramento CA February 2016 – October 2016

Budget Analyst

Strategies Result: Managed and provided financial support to five organizational program areas, and provided a recommendation for improvement regarding the past, current, and projected budget expenditures and allotments.

Reviewed, validated, and maintained database to build the monthly financial statement reports (Income Statement, Balance Sheet, and Cash Flow Statement) for the analyses of spending trends and forecasting for a status of financial health of the organization.

Evaluated the department’s annual proposal budget and analyzed viable alternatives to address potential findings or staffing issues.

Reviewed, analyzed, and processed the Federal Grants and Contracts to ensure the accuracy and completeness.

Coordinated with the governmental legal office to provide the fiscal costing for legislative bill analysis.

California Health Benefit Exchange Board (Covered California), Sacramento CA April 2015 – February 2016

Financial Planning and Analysis Assistant

Strategies Result: Developed and implemented the Financial Statement Reports which were used as a communication channel for the executive team members regarding the company’s finance.

Collaborated with the executive team and professional consultants to research, establish, and implement the Financial Statement Report.

Developed and maintained a data modeling system to extract detailed accounting and budget information to produce periodic financial reports.

Utilized advanced Excel tools such as Pivot Table, charts, and complex formulas (VLOOKUP, and SUMIFS) to work with multiple various sources in order to create financial statement reports.

EDUCATION

California State University, Sacramento, CA December 2015

Bachelor of Science: Health Science, Concentrated in Public Policy and Administration

Graduated with Cum Laude Honor.

Deans Honor List: Fall 2013, Fall 2014, Spring 2015, and Fall 2015.

Scholarship Recipient – AUWW Chapter Women, 2014 -2015 and 2015-2016.

Scholarship Recipient −ANTHONY J. & SOULA LEONES, 2013-2014.

Volunteered for Sutter General Hospital and Sacramento State Multi-Cultural Center

Contact this candidate