Data Analyst Billing Specialist

*

Alvaro G. Leon

Clinical Quality Data Analyst

**** ** ***** **** *****, FL Tel: 305-***-**** Email: **************@*******.*** LinkedIn: https://www.linkedin.com/in/gioleon/

Professional Summary

Highly Individual with 8+ years of experience in the industry in collecting, organizing interpreting and disseminating various types of statistical figures. Enthusiastic team player and confident employee with the ability to circulate information in a way that is clear, efficient and beneficial for end users. Handle solutions and problems and determining modifications for optimal use of organizational data. Areas of Expertise include:

v Project Management v Management Care

Organization

v Star & Hedis

v Management Services

Organization

v Call Center Management v Diversity & Inclusion

v Lean Six Sigma v Strategic Implementation v Health Insurance Marketplace v Operational Leadership v Quality Assurance v Health Outcome Survey v Quality Assurance v Medicaid & Medicare v Patient Education v Inpatient & Outpatient Care v Organizational Development v Medicare Advantage v Problem Resolution v Member Services v Transitional Care Management

Experience

Caremax Inc Miami, FL July 2018 - Present

Caremax, Inc is a Medicare Advantage organization with a full complement of health and wellness services for the senior population.

Clinical Quality Data Analyst

Key Contributions & Process Development

v Coordinate and create Medical Records collection using of one of the various collection methodologies to support HEDIS activities to investigate gaps in clinical documentation for performance improvement. v Analyze data by running SQL reports, sorting and formatting data via Excel and utilizing conditional formatting and other reports.

v Work with Stakeholders by building a relationship by providing timely operational updates, partnering on issues resolution/mitigation strategies, and monitors resolution of identified issues to conclusion. v Working in collaboration with Billing and Coding team for billing and claim coding as well as medical record terminology.

v Responsible for giving our members the best possible treatment from a network of high-quality clinicians and facilities.

2

v Collaborate with the Auditing team to ensure that the entity audits have a successful audit through the auditing process.

Hygea Health Holding – LLC April 2013 – July 2018

Hygea Health Holding LLC is an organization that manages physician practices, ancillary services companies, independent physician associations, and other medical service entities that provide care to commercial, Medicare and Medicaid patient. Senior Billing Specialist – Billing

Key Contributions & Process Development

v Verify all patient demographics and insurance coverage for billing purposes, ensuring the policy that was input the patient chart was accurate and current with the one in the billing system. v Assist billing department with all billing and collections, and data processing to ensure accurate billing and efficient patient account collection.

v Handle daily administration and coordination of billing functions. v Responsible for ordering supplies such as office supplies and all supplies needed by other team members. v Perform the operation of the billing department medical coding, charge entry, claim submission, payment posting accounts receivable follow-up and reimbursement management. Genesis Care February 2007 – April 2013

Genesis Care is the largest provider of radiation therapy across of Australia operating 36 cancer centers in major metropolitan and also regional setting. Genesis Care provides cardiology and sleep services at more than 80 locations. Administrative Patient Financial Counselor

Key Contributions & Process Development

v Obtain, verify and update all patient demographics, data and financial information, utilizing a variety of tools, software and websites.

v Collect and update patient responsibility portion for the treatment visit prior to treatment plan cost. v Meet in-person with patient and family member to screen and complete full Medicaid application, if eligible. v Assist with all steps of Medicaid eligibility and enrollment process. v Educate patients on their EOBs and financial responsibility and solutions for payment of financial responsibility. v Perform other Administrative duties as assigned. EDUCATION, CERTIFICATIONS, AND AFFILIATIONS

EDUCATION

Bachelor of Science in Healthcare Administration

Keiser University Pembroke Pines, FL

Completion: 2017

•Relevant Coursework: Mentoring • Problem Solving • Business Administration & Operations • Patient Care • Data Analysis • Quality Assurance and Control

3

High School Diploma

American Senior High School Hialeah, FL

Completion: 2005

CERTIFICATIONS

v Business Management – Management & Strategy Institute v Certified Healthcare Billing and Management Executive (CHBME) – American Medical Billing Association (AMBA) v Lean Six Sigma White Belt – Management & Strategy Institute v Project Management Professional (PMP) – Practice Management Associates LLC v Clinical Operations – University of Miami

v Certified Professional Biller – AAPC

v Certified Billing and Coding Specialist (CBCS)

v Executive Operation Certification – New York University (NYU) AFFILIATIONS

v The Beryl Institute Member

v National Association of Health Services Executives (NAHSE) v Managed Healthcare Partners LLC

v The Joint Commission

v FEMA Member

v American Medical Association

v Patient Experience Institute

LANGUAGES

v English – Fluent

v Spanish – Fluent

REFERENCES

§ Jennifer Molina § Talent Acquisition Business Partner – CVS

§ Danay Uranga § Colleague at Genesis Care

§ Barbara Jaime § Colleague at Caremax Inc

§ Kenneth Leon § Insurance Agent

Contact this candidate