Sheila Diaz

Oversaw the transition and implementation of a new Electronic Medical Record system to optimize collections , increase documentation compliance and reduce operational redundancies. Full transition completed within one month with minimal financial impact to the practice.

• Develop and implement account plans corresponding to practice goals while boosting revenue from $9M to $14.3M in 3 years.
• Collaborate with MD's in the development of clinical protocols to optimize prior authorization process and management of pre-biologic required labs and diagnostic test to reduce tasks to MD's , optimize clinical adherence and reduce financial liability to the practice.
• Responsible for oversight of the opening of a second practice location in North Naples, covering trend forecasting, budget development, vendor negotiation, deadline management, procurement of government permits, staffing, and marketing.
• Negotiate contracts with vendors and insurance companies to increase practice revenue and margins
• Develop and successfully execute emergency procedures, medication administration protocols, monthly training sessions, and other critical documentation that reduces financial liability and adequately reflects practice capabilities.
• Collaborated with off site prior authorization and billing team in ensuring timely and proper collection and reconciliation of an average of $1.2 M in monthly payments. .
• Manage $1M of monthly revenue on buy and bill inventory on infusions & injectable biologics and other medications on-site.
• Developed , HIPAA & OSHA compliance programs.
• Spearheaded implementation of a new phone system which allowed for development of internal productivity metrics for front office & clinical employees. Reducing patient complaints by 50% and increasing overall patient satisfaction by average of 94%.
• Identified process improvement opportunities to enhance operational effectiveness such as : introduction of new job descriptions, development of new phone queue, front office cross training and development of schedule templates for injections, infusions & E/M visits.
• Build, manage, and develop an Administrative & Clinical team comprised of 20 personnel, provide coaching and mentorship, conduct performance evaluations, and establish inclusive work cultures.
• Collaborate with healthcare providers, insurance companies, and other stakeholders to streamline communication and optimize patient care delivery
• Conduct regular audits of billing processes, coding accuracy, and compliance with regulatory standards to ensure financial integrity and minimize risk

• Developed and executed business strategies to drive revenue and growth.
  Identified and pursued new business opportunities via market research and analysis. Oversaw 3 Account Managers responsible for 30+ clients in Latin America, Asia, and Israel. 
• Actively collaborated with C-level Executives, Account Managers, Marketing department, and the medical team to identify insurance company and TPA prospects, and other potential clients, to ensure the alignment on expansion and growth efforts.
• Conducted hospital visits in Europe and Latin America to ensure the delivery of appropriate care to patients.
• Used clinical knowledge to identify niche treatments for Canadian government clients, contributing to company profitability.
• Developed clinical protocols for clients in Spain, which reduced unnecessary medical treatment and contributed to the minimization of exposure for the expat population living in the US.
• Monitored and analyzed competition and market trends to inform business decisions.

• Oversaw Quarterly Business Reviews for over clients raging from 800k - 14M in yearly revenue. Work alongside 8 Account Managers, in identifying patient utilization trends and developing operational protocols that would protect patients access to care but reduce cost to client.
• Identified opportunities for Business Development in Canada by leveraging existing relationships and developing internal clinical protocols to better assists patients receiving CAR-T therapy in the US.
• Established strong connections with new hospital and physician groups to expand GMMI’s network.
• Identified and provided advice on how to improve business and boost revenue by strengthening relationships with top international accounts.
• Educated clients regarding U.S.-based healthcare practices on a global level. Served as SPOC during GMMI cost containment Lead Six Sigma transformation.
• Directly oversaw the third largest account at GMMI responsible for 15% of company's revenue.
• Collaborated in the development of a commercial strategy during the COVID pandemic in assisting clients navigate newly developing critical protocols while shifting business expansion away from travel insurance policies.
• Liaised with key Operations, Finance and Billing to ensure contract compliance of SLA's.

• Expanded Canadian government portfolio by leveraging strong relationships with existing clients and developing deep market understanding, resulting in $8M of additional revenue.
• Established and maintained trusted relationships with high-level accounts by exhibiting strong clinical talents and identifying utilization trends for member populations.
• Increased long-term revenue by establishing provider relationships via hospital visits and event participation to maximize the influence of potential event sponsorships and negotiations.
• Successfully oversaw client accounts to maintain favorable relationships.
• Developed commercial strategies via identification of niche markets.
• Streamlined operations through introduction of innovative clinical protocols.
• Engaged with stakeholders to ensure cross-training and referral opportunities.
• Liaised between cross-functional teams and customers to ensure the successful delivery of solutions to customer needs.
• Managed a portfolio of key accounts, including developing strategic account plans and providing exceptional customer service to ensure client satisfaction and retention.
• Conducted regular business reviews with clients to review performance metrics and identify opportunities for expansion and upselling.

• Applied Milliman Care Guidelines to identify key opportunities for cost containment while overseeing patient admissions and coordinations of patient discharge.
• Effectively assessed and implemented, options and services required to meet the healthcare needs of patients by demonstrating experience with Utilization Review, discharge summaries,and case management protocols
• Developed and executed clinical guidelines and protocols to ensure the delivery of high-quality care.
• Identified possible barriers for a safe patient discharge and repatriation back to home country. Once identified, assisted in outlining and coordinating resources for a safe departure.
• Promoted quality patient care via the use of cost-effective and outcome-management criteria.
• Managed government contract with the Embassy of Kuwait, assisting its citizens receiving medical treatment in the U.S.
• Ensured adherence to accreditation and regulatory standards, carrying out regular audits to determine areas for improvement.
• Led a team of medical case managers to coordinate care for patients with complex medical needs, ensuring timely and appropriate treatment plans were implemented.
• Oversaw the coordination of care among multiple healthcare providers, ensuring seamless communication between them and the insurance payer to provide a timely and safe patient discharge.

• Manage patients through detox of highly addictive non prescribed substances , constantly communicating with physicians and care team for seizure management and prevention, monitoring for possible cardiac and neurological events while in active detox.
• Provided holistic approach to patients in the correctional setting including patient assessment , wound care , medication management , management of exacerbation of chronic conditions that were often poorly managed prior to their incarceration.
• Part of the immediate medical response team which included management of seizures , IM medication administration , oxygen administration as per protocol, and coordinating transfer to hospital setting with physician and nursing staff.
• Oral medication administration, preparation, review and discontinuation of physician orders to 4 units per shift encompassing over 100 patients daily.
• Provided high-quality nursing care to patients under the supervision of physicians and registered nurses.
• Monitored, recorded, and reported any changes in patients' conditions, including reactions to medications, symptoms, and vital signs.
• Effectively collaborated with registered nurses, physicians, and other healthcare professionals to develop and execute individualized care plans.
• Provided patient education , regarding medication management post release , including importance of compliance with medications for management of chronic conditions such as HIV. Helped patients understand the social barriers to obtaining care and reviewed low cost resources available to the community for continuity of care.

• Conducted complete patient assessments to determine symptoms and control the progression of rheumatic diseases.
• Closely collaborated with multidisciplinary teams of healthcare professionals by managing physician referrals and coordination of diagnostic testing with other facilities to ensure prompt initiation of treatment.
• Educated patients and their family members about treatment plans, self administration of injectable biologics and how to identify potential adverse events.
• Provided counseling regarding the importance of diet, exercise and medication compliance regardless of active symptoms to minimize exacerbations of their condition.
• Built and manage provider schedule to ensure practice monthly and quarterly goals were met.
• Guided preventative care measures to minimize the risk of disease progression.
• Administered medications such as Methotrexate , Cimzia , IV Reclast, Depomedrol injections and nursing interventions as prescribed by physicians.