Alma Acosta
Director of Operations
San Antonio,TX
Work Preference
Summary
Dynamic quality assurance professional with extensive experience in leading quality assurance and control processes. Proven track record in fostering team collaboration while ensuring compliance with industry standards demonstrates a commitment to excellence. Recognized for adaptability and ability to deliver consistent results through strategic quality management initiatives. Passionate about driving continuous improvement and enhancing operational efficiency within diverse environments.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Director of Quality Operations
WellMed Medical Management
11.2020 - 01.2026
- Successfully led 5 STAR goals for Medicare and Medicaid lines of business with oversight of over 150K members.
- Improved Consumer Assessment of HealthCare Providers and Systems (CAHPS), Health Outcomes Survey (HOS) scores with actionable data.
- Lead, monitor and tracked current performance from clinical level to contract level improving STARS ratings YOY per contract.
- Built strong partnerships with key stakeholders, enabling increased collaboration on problem-solving efforts and overall process improvements.
- Streamlined internal audit procedures by developing standardized templates for reporting findings efficiently and consistently improving internal and external IRR rates YOY.
- Lead deep dive analysis for all quality metrics, efforts and vendor strategies improving YOY gap closures leading to 0.5 to 1 STAR improvements
- Collaborate with various leaders across the enterprise to establish objective and impactful strategic initiatives to reduce team administrative burden.
- Led quality improvement initiatives to enhance patient care and operational efficiency.
- Analyzed data trends to identify areas for quality enhancement across services.
- Facilitated training sessions on new quality standards, developed SOP's and continuous improvement strategies to improve EYE gap closure rates YOY.
- Established key performance indicators to measure effectiveness of quality initiatives.
Family Nurse Practitioner
WellMed Medical Management - United Health Group
05.2020 - 08.2021
- Conducted comprehensive health assessments to develop personalized care plans for diverse patient populations.
- Collaborated with interdisciplinary teams to enhance patient outcomes and streamline care delivery processes.
- Managed chronic disease treatment protocols, ensuring adherence to best practice guidelines and improving patient compliance.
- Educated patients on preventive care strategies, promoting wellness and enhancing community health awareness initiatives.
Senior Consultant, Education & Quality Analytics
Conviva Care Solutions
01.2016 - 01.2020
- Responsible for organizing, leading, implementing and supervising day to day operations for performance improvement programs for process and outcome measures improving gap closure rates YOY.
- Collaborated with call center to improve Medication Adherence rates and targeted quality metrics utilizing data to drive performance and create best practices.
- Managed and developed new relationships with key stake holders/vendors to ensure milestone achievement.
- Provided oversight and support to multiple markets in the Greater Texas area while driving YOY STARs improvements in all markets.
- Successfully led 4 PLUS Star plan for Greater Texas market.
- Conducted cost-benefit analysis to justify investments and improving market ROI
- Mentored junior consultants, fostering professional growth and improving team performance metrics.
- Streamlined operational workflows through data analysis and best practice implementation, driving efficiency gains in quality and risk performance.
- Facilitated workshops for senior leadership on emerging healthcare technologies and innovative service models.
- Established key performance indicators to measure success of consulting projects, optimizing resource allocation and outcomes.
Senior Clinical Coding Consultant
WellMed Medical Management
01.2008 - 01.2016
- Served as content expert in Operations, MRA and HEDIS for current and expansion market.
- Responsible for onboarding and training new employees/clinicians to the market maintaining compliance with AAPC coding standards and CMS Risk Adjustment and NCQA Guidelines.
- Led and supported ITC (intake transition clinic) to assist with capture of risk, quality metrics and chronic conditions improving patient care.
- Documented excellence in risk adjustment systems, clinical education and engagement strategies.
- Broad working knowledge of ICD-10 DM guidelines, CMS regulations, NCQA, HEDIS and STARS.
- Execution and delivery with considerations in therapeutic, prospective and point of care risk adjustment strategies in Medicare, Medicaid and ACA markets.
- Assisted in Clinical algorithm development for risk adjustment analytics improving rates YOY.
- Developed training materials for staff on coding practices and compliance requirements, fostering a culture of continuous improvement.
- Analyzed coding processes to enhance compliance with regulatory standards and improve overall accuracy.
Education
Master's Degree - Family Nurse Practitioner
Texas A&M
Corpus Christi, TX05.2020
Associate of Science - Registered Nurse
Del Mar College
Corpus Christi, TX05-1994
Skills
- Extensive quality assurance experience
- Proficient in clinical informatics practices
- Educational instruction experience
- Geriatrics - 15 years
- Advanced Practice - 2 years
- Case Management - 5 years
- 15 years of administrative experience
- Operational excellence
- Quality risk assessment
- Corrective and preventive actions
Accomplishments
- Supervised team of 10-50 staff members.
- Documented and resolved Medication Adherence barriers which led to YOY STARS improvement.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Certification
- RN - Texas COMPACT
- NP - Family/Individual
- CPR
- Certified Risk Coder (AAPC)
- Certified Professional Coder
Languages
Spanish
Professional Working
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Director of Quality Operations
WellMed Medical Management
11.2020 - 01.2026
Family Nurse Practitioner
WellMed Medical Management - United Health Group
05.2020 - 08.2021
Senior Consultant, Education & Quality Analytics
Conviva Care Solutions
01.2016 - 01.2020
Senior Clinical Coding Consultant
WellMed Medical Management
01.2008 - 01.2016
Master's Degree - Family Nurse Practitioner
Texas A&M
Associate of Science - Registered Nurse
Del Mar College