Safety Specialist Prior Authorization

Christian Iglesias

*** *. ***** *** ****, AZ ****0 480-***-**** *************@*****.***

Summary of Qualifications

Experience in information security, specifically with penetration testing, intrusion detection, incident response or digital forensics

Three years of experience installing network hardware and software, including network operating systems

Ability to maintain and control computer networks and related computing environments together with structures software, programs software, hardware, and configurations

Proficient in troubleshooting, diagnosing and resolving software, hardware, and other network and system problems

Experience with the layout of the design and implementation of new solutions to improve the resilience of the modern surroundings

Fluent in both Spanish and English with the ability to read, write, speak, and translate and vice versa

Demonstrates reputation of dependability, organization, and critical thinking in the workplace

Excellent written, interpersonal and oral communication skills

Degrees in Cisco Networking and Cybersecurity

Working on CCNP.

Technological Proficiencies:

Programming language: Python

Operating systems: Microsoft, Linux, AWS cloud computing

Education

Bachelor of Science Arizona State University – Tempe, AZ

Associate in Applied Science in Networking Systems & Administration Mesa Community College – Mesa, AZ

Associate in Applied Science in Cyber Security Mesa Community College – Mesa, AZ

CNT Networking Project Experience

CNT140AB – Introduction to Networks

Skills Gained:

Established and maintained network performance, built net configurations and connections, troubleshooting network problems, and establishes networking environment by designing system configuration and directing system installation

Defined, documented, and enforced system standards, maximized performance by troubleshooting network problems and outages and scheduling upgrades

Configured router and updated data servers and network equipment, collaborated with all teams to monitor and optimize network performance

Updated and maintained status of work on all assigned projects and secured network system by establishing and enforcing policies and defining and monitoring access

CNT150AB – Switching, Routing, and Wireless Essentials

Skills Gained:

Internet Protocol (IP) address management. Domain Name Server (DNS) administration. Understand dynamic multipoint VPNs. Monitor, create, edit and enforce all standard operating procedures, processes and timelines

Maintains and updates job knowledge by participating in educational opportunities, reading professional publications, and participating in professional organizations.

CNT160 – Enterprise Networking, Security, and Automation

Skills Gained:

Conduct daily analysis of all servers, identifies and characterizes incidents, generates incident reports, and investigates suspicious activity on all servers. Responsible for backup and validation of backups on all servers. Troubleshoot and isolate server issues (Hardware and Software), and work to resolve with all necessary parties required (Server Hardware and Software manufacturers).

Professional Experience

Infosystems November 2021- present

Help trouble shooting user accounts information over the phone.

Document security issues and maintaining security measures.

Respond to plan participant inquiries pertaining to certain legal, regulations, and tax related issues through verbal and written communication.

Initiate transactions for participants including loans, exchanges, allocations, and terminations.

Provides industry knowledge to fund performance and retirement investing.

Provide fund and investment performance information to participants by phone.

Client Relationship Group, Retirement plan productions and services

Clinical Reviewer TriWest Health Care Alliance – Tempe, AZ February 2014 to End of Nov 24

Acquire clinical information and help set preauthorization for specific medical procedures and services. Conducts prior authorization activities and referral management activities

Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and Behavioral Health criteria. Ensures timely reviews for requesting facilities and appropriate notification to parties

Process Pre-Authorizations, procedures, and codes

Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as URAC and NCQA guidelines.

Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

Reviews appeal cases and/or attends hearings for discussion of utilization management decisions

Answer a diverse and high volume of health insurance, medications, and durable medical equipment related customer calls or correspondence on a daily basis.

Occupational Ergonomic Health &Safety Specialist JBS- Beef Plant – Tolleson, AZ October 2010 to January 2014

Basic Knowledge of Osha guidelines and Workers’ compensation claims.

Helped schedule health assessments and evaluated employees for return to work, fitness for duty, and medical surveillance in accordance with health management and safety protocol.

On a daily basis, I monitored employees who are in conservative treatment or return to work to include the treatment modalities, restricted work activity, and ergonomic interventions.

Assisted with continuous quality improvement of workers compensation claims submission policies, procedures, processes and programs

Assisted in case management through building a rapport with the local medical community for both work related and non-work related events

Performed front office clerical duties such as answering telephone, check in, check out and record keeping

Responded to emergency situations and triaged with little supervision. Provided first aid treatment, wound care, follow up care, rehabilitation service, counseling, and referral to medical liaison for all types of health issues.

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