Quality Assurance Health Plan

Franco C. Pliego

E-Mail: ********@*****.*** *** Buena Vista Ave. Pomona, CA 91766 Cell: 909-***-**** OBJECTIVE

Continue to further my skill set and build upon my proficiency in a highly complicated system of policies, workflow, and professional capacity - while pursuing a career allotting for my own personal growth, satisfaction, and honor. EDUCATION

Mt. San Antonio Comm. College (Walnut, CA) University of California, Riverside (Riverside, CA) AA Degree – Interpersonal Communication BA Degree – Public Policy WORK EXPERIENCE

Call the Car [Quality Assurance Specialist] (2024 - Present)

• Records and initiates the investigation of complaints/grievances concerns directly with Health Plan members.

- Health Plan (i.e. IEHP, BSC, LAC, CCAH)

• Ensures timely communication, review & resolution of concerns, complaints, and grievances amongst Health Plans.

• Reports need for corrective workflow action amongst Health Plan processes to Quality Assurance Manager.

• Works closely with Call the Car management to ensure compliance of quality standards.

• Identifies and reports trends in complaint categories and organizes weekly briefings to Quality Assurance team.

• Research of issues related to customer satisfaction surveys and constructs corrective action plans to address.

• Gathers and submits information reports related to member injuries and vehicle accidents, along with potential fraud, waste and abuse concerns to the Health Plan and Call the Car leadership. Tri-City Mental Health Services (TCMHS) [Quality Improvement Specialist I] (2018 – 2023)

● Organized and prepared regular QA audits on a weekly basis.

● Provided quality control and compliance, while communicating amongst clinical staff to supervise the completion of documentation concerns identified.

● Managed the onboarding of new staff and facilitated their integration as new clinical team members.

● Increasingly complex correspondence with team members and other Tri-City Staff to provide support during a complete system change of our Electronic Health Record (E.H.R.).

● Administered the transition of pre-pandemic compliance to post pandemic protocols as it pertained to documentation, and E.H.R. standards.

● Operational lead on agency wide clinical forms tracking system, cataloging the forms used and providing tracking numbers and maintaining project files/updates to documents in our shared drives.

● Maintained quality standards to TCMHS website, and the internal system used to offer documentation amongst staff and to the community.

A-1 Home Care Agency [Care Coordinator/Assistant Manager] (2016 - 2018)

• Managing correspondence: Clients, Insurers & Government Agencies, alongside billing and managerial departments.

• Heavy data entry: analyzing information from new clients, applicants, and insurance claims.

• Customer service liaison: educating families on end of term care/financial avenues to provide adequate support. DISTINGUISABLE RECOGNITIONS SKILL

Induction Into:

TAU.SIGMA National Honor Society

Induction Into:

DELTA.EPSILON.IOTA Academic Honor

Society

Certifications:

Lead Work Safety - City of Pomona

(2023)

Language:

- Proficiency in reading, writing, and speaking Spanish / Intermediate French. Tech Aptitude:

- Proficiency in large file organization and tracking on a Shared Network. Electronic Health Record Experience:

- Welligent Administrative & Report managing/Auditing & Implementations.

- Cerner Training and onboarding clinical staff while facilitating an agency wide transition from with limited support.

Contact this candidate