Experience

Agilerta- CVO

• Puerto Rico
• Hospitals and Health Care
• 1 - 100 Employee

• Operations Department Supervisor

  • Apr 2016 - Present

  Lead the company's internal and external work team, creating and following up on weekly work plans. Maintain daily production required by daily operation. Coaching resources that their performance is affected, continuity of training in established and new processes to meet the company's goals. Extensive audit of all internal and regulatory processes of the company. In turn, ensure compliance with contractual regulations with entities and regulations for a CVO (Credentialing Verification Organization) under the NCQA certifications. Show less



Triple-S Vida

• United States
• Insurance
• 100 - 200 Employee

• Licensed Insurance Agent

  • Oct 2015 - Apr 2016

  Counselor and facilitator of life insurance policies and property, according to the needs presented by the client. Personalized attention to all our customers in our businesses portfolio. Counselor and facilitator of life insurance policies and property, according to the needs presented by the client. Personalized attention to all our customers in our businesses portfolio.



MCS Puerto Rico

• Puerto Rico
• Insurance
• 700 & Above Employee

• Providers Relations & Services Specialist

  • Mar 2004 - Oct 2015

  Vast knowledge in coordinated care models (MOC) in business lines of the Government Health Plan and Advantage programs (Medicare) Service provider as your needs, hiring, audit claims submitted to the insurer, insured care complaints, case management insured with especial covered. Orientation billing processes and payment rules (NCCI) and coding ICD9 and ICD10. Policy guidance and procedures for the business lines of the company (Commercial, Advantage, Health Insurance of the Government). Also intermediary processes payments for providers. Show less



AFSCME

• United States
• Political Organizations
• 700 & Above Employee

• Computer Network Administrator

  • Feb 1998 - Nov 2003

  Computer network administrator. Creating user accounts, database administrator and reporting. Permissions controls within the users network. Hardware and software. Computer network administrator. Creating user accounts, database administrator and reporting. Permissions controls within the users network. Hardware and software.



University Pathology Group PC

• Hospital Auxilio Mutuo, San Juan PR

• Customer Service Representative

  • Mar 1997 - Sep 1998

  Customer service orientation on tests or studies that would be undertaken. Preparation of tissue samples for various pathological tests. Case preparation for Tumor Board meetings where they were exposed to better cancer treatment. Customer service orientation on tests or studies that would be undertaken. Preparation of tissue samples for various pathological tests. Case preparation for Tumor Board meetings where they were exposed to better cancer treatment.