Christian Pereira
Miami,FL
Summary
Skilled at preparing and submitting regulatory documentation, including reviewing materials, technical data and accuracy of filings. Articulate and personable with exceptional data analysis, report writing and recordkeeping abilities.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Grievance and Appeals Regulatory Analyst
Molina Healthcare
04.2022 - Current
- Collaborated with cross-functional teams to address any identified gaps in compliance or areas requiring improvement.
- Resolved complex regulatory issues by leveraging strong problem-solving skills and a deep understanding of industry guidelines.
- Conducted regular audits of internal processes to verify compliance with established policies and regulations.
- Improved regulatory compliance by conducting thorough research and analysis of federal, state, and local regulations.
- Influenced positive change within the organization by identifying process improvements aimed at increasing efficiency without compromising compliance standards.
Grievance and Appeals Sr Auditor Analyst
Elevance Health (Anthem)
08.2019 - 04.2022
- Reduced instances of non-compliance by conducting thorough audits and providing clear recommendations for improvement.
- Championed a culture of ethical decision-making and compliance within internal audit team through ongoing training and education initiatives.
- Enhanced audit efficiency by implementing risk-based audit strategies and streamlining processes.
- Prepared working papers, reports and supporting documentation for audit findings.
- Developed audit policies, guiding administrative and technical functions.
- Created a more collaborative work environment by fostering open communication channels between auditors, management, and other departments in organization.
Grievance and Appeals Analyst III
Humana
12.2017 - 08.2019
- Handled escalated cases adeptly, applying advanced problem-solving skills to resolve highly complex or contentious issues.
- Streamlined workflows for faster decision-making, evaluating medical records and other documentation to support appeals decisions.
- Managed high volume of cases, prioritizing tasks effectively and meeting strict deadlines for appeals and grievance resolutions.
- Collaborated with interdisciplinary teams to ensure accurate claims adjudication, reducing errors and inconsistencies in review process.
- Navigated regulatory requirements proficiently, adhering to state and federal guidelines throughout the G&A process.
Patient Access Representative Supervisor
Nicklaus Children's Hospital
04.2015 - 12.2017
- Contributed to a positive work environment by fostering strong relationships among colleagues, promoting teamwork, and sharing best practices.
- Trained new hires on department procedures, policies, and software systems, ensuring consistent quality service delivery from all team members.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Participated in ongoing professional development opportunities to stay current with industry trends and best practices in patient access services.
Education
Bachelor of Arts - Business Administration And Management
Broward College
Florida08.2019
Skills
- Business Analysis
- Relationship Building
- Supervision and leadership
- Compliance Reporting
- Data Analysis
- Audit Documentation
Certification
- Digital Marketing & E-commerce Certificate
- 2-40 Health insurance License
Timeline
Grievance and Appeals Regulatory Analyst
Molina Healthcare
04.2022 - Current
Grievance and Appeals Sr Auditor Analyst
Elevance Health (Anthem)
08.2019 - 04.2022
Grievance and Appeals Analyst III
Humana
12.2017 - 08.2019
Patient Access Representative Supervisor
Nicklaus Children's Hospital
04.2015 - 12.2017
Bachelor of Arts - Business Administration And Management
Broward College
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