San Diego Metropolitan Area
Healthcare operations leader with 15+ years of experience leading risk adjustment, coding compliance, and revenue protection initiatives in highly regulated environments. I specialize in building and scaling high‑performing teams, improving accuracy and turnaround times, and ensuring audit‑ready operations across multi‑site organizations. My background includes leading national coding operations, partnering with compliance and executive leadership, and delivering measurable improvements in quality, efficiency, and financial protection. I am known for a disciplined, data‑driven leadership style and a strong focus on accountability, operational excellence, and team development.
I successfully directed the risk adjustment coding operations, achieving measurable improvements in quality and compliance. • Championed continuous improvement initiatives, resulting in a 25% reduction in coding errors. • Managed vendor relationships to ensure performance standards were met, optimizing staffing and operational efficiency. • Provided executive-level insights that supported strategic decision-making and drove organizational growth. • Set and implemented short and long-term strategies for risk adjustment coding, aligning with corporate goals. • Led a high-performing team, ensuring compliance with CMS, HHS, and NCQA standards while enhancing coding accuracy. • Developed robust quality control processes, resulting in a 20% increase in coding accuracy and a significant reduction in compliance issues.
Optum Health Operations Management for Risk Adjustment Coding, Intake/EDPS
Guided employees in meeting customer needs and improving morale through recognition practices. Led cross-functional teams for process improvements and new product launches. Managed recruitment, training, and performance evaluation to meet staffing needs and mitigate risks. Improved operational efficiency by monitoring processes, analyzing KPI trends, and creating corrective actions. Supported senior leadership with detailed reports for informed executive decision-making. Ensured regulatory compliance and maintained a safe work environment for personnel. Crafted best practices and improved communication through performance audits and feedback.
Univita Health Inc. Operations Management for Appeals/Complaints, Claims Exam, and Intake
Increased project approval rate by 25% by developing analytical assessments for crucial decision-making. Participated in subordinates' tasks to facilitate productivity or help overcome difficulties. Created systems that enabled more efficient use of resources while also reducing waste. Accomplished leader, skilled at maximizing employees skills and knowledge, to achieve highest performance goals. Reviewed employees' work to check adherence to quality standards and proper procedures. Hired, trained, evaluated and retained high-performing, effective and diverse team embodying organizational culture. Issued work schedules, duty assignments and deadlines for office or.
Improved performance by 15% by implementing new processes and identifying 5 key improvement areas. Resolved customer complaints promptly, maintaining high satisfaction and developing strong customer relationships. Provided leadership and mentorship to employees, training them on job functions, and company policies. Led team collaboration efforts, combining strengths to achieve organizational goals. Reviewed employee performance metrics, offering solutions to improve productivity and engagement. Delegated tasks, setting priorities to meet operational demands. Formulated successful strategies for the organization's financial welfare, enhancing profitability.
Led and supervised new employee training, ensuring efficient onboarding and enhanced team productivity. Delivered leadership and mentorship to newly hired employees, providing knowledge of company programs and processes. Managed daily operations and client relations, overseeing departmental efficiency and fostering cross-departmental collaboration to address customer needs. Resolved escalated customer complaints promptly and developed processes to enhance customer satisfaction and decrease response times. Assess and improve call center operations by documenting process changes, analyzing customer feedback, and conducting performance reviews to boost service delivery. Ensured compliance with privacy protection laws and cultivated high-performance through targeted employee incentives and monitoring for quality assurance. Directed and coached team members on metrics and consumer experience behavior, elevating satisfaction ratings and achieving high performance.