Connie Osorio

***** ******* *****

Cell: 510-***-**** Castro Valley, CA 94546 aduqqs@r.postjobfree.com

SUMMARY

Energetic and personable Service Professional with more than 15 years’ experience in Health Care industry with particular experience in Quality Assurance, exceptional planning, prioritizing and multi-tasking skills resulting in ability to consistently meet goals and expectations.

CORE COMPETENCIES

Bilingual Spanish Support Changes and New Ideas

Effective Team Player Risk Analysis

Active Problem Solver Delivers Outstanding Presentations

Take Ownership and Accountability of tasks Work Flow Optimization

Creatively Meets Customer Needs High Level of Productivity

PROFESSIONAL EXPERIENCE

Kaiser Permanente, Oakland Nov 2018 – October 2021

Medical Services Contracting

Senior Business Proc Analyst

Responsible for a range of process improvement and process management activities. Activities include planning, performing, and implementing process improvement initiatives, in addition to ownership of operational processes. These initiatives may represent one portion of a larger project, or may represent a standalone initiative or function within a work group or department..

Process management functions may include data gathering and analysis, best practice research, process mapping, developing and recommending alternatives for improvement, developing performance metrics, obtaining leadership or stakeholder agreement, implementing improvements, and monitoring post-process improvement initiative performance to updated standards. Activities are undertaken and executed in support of organizational goals and are accountable for providing business process solutions to meet internal and external customer expectations. May utilized Lean/Six Sigma processes and concepts to lead process improvement initiatives. Partners with management, project champions, and process owners to executive the project and deliver results.

Essential Functions:

•Data Analysis: identifies data sources gathers and analyzes stat relevant to processes identified for process improvement initiatives. May recommend data requirements.

•Research: May research and summarize best practice standards relevant to process management. Males recommendations on appropriate solutions based on research.

•Process Architecture: Designs and maps processes using defined methods. Ensure process mapping is complete; map provide feedback and guidance to less senior analysis /consultants. Interviews stakeholders and process owners to define processes.

•Process Recommendations: Prepares process recommendation documents, including presentations, process maps, supporting metrics, business requirements and related impact analyses for less complex processes or for portions of larger or inter-related processes. May apply Lean/Six Sigma concepts and techniques to process improvement initiative, including completing Lean/Six Sigma analyses and tasks.

•Performance Management & Control: Develops performance metrics to establish process success. Reviews data post-implementation to measure outcomes and impacts. May develop recommendations to minimize impacts.

•Change Management: Participates in change management activities associated with process improvement. Engage leadership and stakeholders to obtain support and buy in for changes. Partners with management, project champions, and process owners to align process improvement initiative with business objective.

Kaiser Permanente, Oakland Jan 2015 – Nov 2018

Medical Services Contracting

Sr. Provider Relations Coordinator

Responsible for providing ongoing support to Medical Services Contracting Provider dispute team and contracted providers within Network. Working directly with Dispute Team, Contract managers, and internal KP stake holders to support and identify billing or payment issues with contracted providers.

Essential Functions:

• Process, research, and resolution of Provider bulk billing and payment disputes. Resolve all Chats cases assigned to MSC unit.

• Researches and compares contract rates and claims for accuracy.

• Preparation and analysis of monthly dispute reports.

• Serves as a liaison and develops strong relationships between KP, contractors and the network providers.

• Participates in staff meetings and training of new temporary staff members.

• Responds to questions, information requests and problems from providers.

• Acknowledges and maintains absolute confidentiality of sensitive information.

• Fills the role of provider advocate.

• Leads or supports miscellaneous projects as needed.

• Identifies and resolves billing and payment issues within the context of the contract and regulatory agency guidelines. Identifies, researches, and facilitates resolution of operational issues involving the networks.

• Conducts research and assists in the coordination and collection of program data.

Kaiser Permanente, Oakland May 2013 – Jan 2015

HealthWorks / Product Innovation

Data Analyst / Program Coordinator

Responsible for Monthly Financial Reporting, analysis, support, coordination and onboarding of KP services to help employer workforce populations improve their health and wellness and better manage chronic conditions.

Essential Functions:

Assists in the development of program proposals, recommendations, implementation plans, communication packages, performance measurement tools, and training materials related to the assigned projects. Manage and coordinate sold HealthWorks programs that include onsite health screenings and classes, marketing and communications, rewards and incentives, access to online health programs and reports that assess the participation and success of programs.

Kaiser Permanente, Oakland June 2012 – May 2013

Member Services

Senior Consultant, Medicare Part D Unit

Analyze and approve Pharmacy Part D claims. Adjudicate claims, complete audits, and adjust claim examiners' settlement limits. Review settled insurance claims to determine that payments and settlements have been made in accordance with legal compliance, company practices and procedures. Review covered losses, establishing proof of loss, overpayments, underpayments and other irregularities. Meet and exceed defined quality levels. Demonstrated competency in claim risk analysis, medical terminology, logical thinking and Microsoft applications.

Kaiser Permanente, Pleasanton Oct 2008 – May 2012

Member Services

Senior Case Manager

Accountable for independently investigating, documenting, analyzing and responding to all member grievances and complaints including benefit, medical necessity, durable medical equipment, and internal/external services, including collection of data, preparation, and presentation of case documents to committee decision makers. Strong working knowledge of Federal & State regulations, law regulations & accreditation standards related to health care & managed care organization. Mentor others in preparation for positions of increased responsibility. Participate in departmental meetings, trainings, and audits.

Kaiser Permanente, Regional Float Pool Sep 2008-Oct 2008

Senior Staff Assistant

Duties: Under limited supervision, served as administrative liaison between manager and direct reports and others within and outside the organization by providing advanced, highly responsible administrative support. Activities ranged from routine to moderately complex, requiring a greater level of judgment and initiative to determine proper approach or action to take in non-routine situations and extensive knowledge of the organizational unit served including typical operating policies, procedures, and protocols, and administrative concepts, principles and accepted practices in the occupation

Wachovia (First Place Contracted Temp Position) Sep 2008 to Oct 2008

FHA Connection Specialist

Accountable for independently investigating, documenting, analyzing reviewing and submitting registered mortgage loans to be sold to Federal Housing Administration.

Wachovia (formerly World Savings), San Leandro, CA 2005-2008

Processing Team Lead (2006- July 2008)

Managed and directed 16 Closing Specialists and Processors with packaging support. Consistently interfaced with borrowers, loan offices, consultants, title companies, escrow and appraisers to ensure all documents were submitted and received timely. Reviewed and ordered necessary documents including title and flood insurance, tax certificates, surveys and reviewed information for problems and exceptions.

·Trained and developed new hires and served as mentor coach to educate on company policies and guidelines to minimize slow production.

Designated as first point of contact for any customers issues to increase customer satisfaction.

·Excellent knowledge of federal and state regulatory requirements on specific loan products to assist customers with questions and best loan package information.

Quality Assurance Manager, Home Loan Experts Department (2005-2006)

Accountable for independently investigating, documenting, analyzing reviewing credit and mortgage loan applications. Strong working knowledge of Federal & State regulations, law regulations & accreditation standards related to Finance.

Previous Employment and Health Care Experience: (2006 -1988)

·Gateway Bank, FSB, Loan Manager

·Southern Wine & Spirits, Officer Manager/ Executive Assistant

·American Medical Response, Claims and Accounting Billing Specialist

·St. Michael’s Skilled Nursing Facility, Claims processor for Medicare & Medi-cal, and Private Billing

·RMG Physicians Billing Company, Emergency Physician Claims Processor, X-ray Claims for San Leandro Hospital formerly Humana Hospital (San Leandro, CA), Mercy Hospital (Sacramento, CA), and Dameron Hospital (Stockton, CA)

·Med Data Medical Group, Emergency Physician Claims processor for San Francisco General Hospital

QUALIFICATIONS

Software: EPIC Care Electronic Medical Record (EMR), Ambulatory, Catamaran formerly HelathTrans (Medicare Claims Adjudication Tracking System), CATS (KP Claims Adjudication Tracking System), Durable Medical Equipment Order Tracking (KP DME system), KP Foundations System (Reflection), Word, Excel, PowerPoint, Access, SQL, Customer Relationship Management (CRM), Customer Analytics and Reporting (CAR), iFile, AOMS, Mainframe, Peoplesoft, SharePoint, Salesforce/Sales Cloud, and Publisher.

Audit /Revenue Capture: Case auditing for revenue capture and re-capture opportunities, Data integrity management recommendations/solutions, Accounts Payable/Receivable, Balance Sheet, Income Statement, General Ledger, Account Reconciliation, and Audit Preparation.

Project Coordinator: SharePoint Project assisted in Data Migration Jan 2014. Member Service Training Team; Orphan Issue and Service Project Jan 2012.

PROFESSIONAL DEVELOPMENT and CAREER HIGHLIGHTS

2018 MSC Rock Star Awards recipient June 2018 for 100% compliance, March 2018 for completion Burn Down project (over 1,000 disputes)

2017 MSC Rock Star Awards recipient September 2017 processing highest number of provider disputes.

2016 MSC Collaboration Recognition Awards recipient September 2015 for getting Easter Seals to withdraw multiple bulk disputes. Support to overall success of the Provider dispute unit. November 2015, Nimble response to the dispute audit by KP’s Medi-cal Plan partners.

2012 to 2010 Team Captain, Commercial, Member Case Resolution Center, Kaiser Permanente

2007 Learning Consultant, Training for New Financial Software Implementation, Wachovia Bank

2007 Outstanding Manager Award, Wachovia Bank

2006 Employee of the Month, Wachovia Bank

2006 Voted Most Valued Participator, Wachovia Bank

2006 Mortgage Loan Underwriting Certification, Wachovia Bank

2001 and 1999 Employee of the Year Awards, Southern Wine & Spirits

Education:

Chabot College, Hayward, CA General Studies Undergraduate

St, Paul High School, San Francisco, CA, Graduate

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