Diane L Ramos
Fresno,California
Summary
A former supervisor with over 20 years of experience in managed healthcare. Comprehensive knowledge of operations, benefits, and plans. A successful post-secondary educator with a passion for advocacy. Excited to leverage my skills while taking on new challenges for continuous personal growth and professional development.
Overview
28
28
years of professional experience
Work History
Benefits Advocate
CNO Financial
07.2022 - 04.2023
- Assisted individuals in choosing health plans that best fit their needs
- Educated individuals on benefits and plans processess
- Navigated complicated medical claim processes and procedures on behalf of members
- Performed transparency pricing for high deductible plans, finding lower cost options
Healthcare and Coding Instructor
UEI College
11.2010 - 08.2013
- Maintained 3% and less student attrition
- Performed Q&A for annual board meetings
- Evaluated student performance levels to provide reports on academic progress
- Applied innovative teaching methods to encourage student learning objectives
- Met with students to dispense study and career advice and provide guidance and potential opportunities within chosen field
Medicare Operations Supervisor
Aetna Health Plans
06.2000 - 12.2008
- Successfully managed 32-34 advocates in multiple offices
- Developed policies and procedures that aligned with Medicare regulation and compliance
- Hands-on, recruiting, hiring, and staff development
- Adherence to HR procedures and protocols
- Identified issues, analyzed information and provided solutions to problems
- Established repore with CMS, working directly with auditors
Business Information Specialist
Aetna Health Plans
04.1999 - 06.2000
- Project management
- Worked with IT on software applications and testing new products
- Medicare subject matter expert
- Handling of CMS compliance audits and implementation of action plans
- Communicated and collaborated with vendors to streamline protocols and align efforts for better efficiency
- HIM processing
Claims Benefit Analyst
Aetna Health Plans
06.1995 - 03.1999
- Teamlead
- Conducted resolution through research
- Developed improvement strategies for calls and claims
- Daily reporting and monitoring
- Conducted high-dollar claim stop-loss review
Education
Bachelor of Science - Sociology
Arizona State University
Tempe, AZ05.2024
Associate of Arts - Sociology
Fresno City College
05.2020
Skills
- Managed Healthcare
- Medicare/CMS
- Verbal and Written Communication
- Analytical and Critical Thinker
- HIPAA, Policies and Procedures
- Medical Coding and Terminology
- Medicare Regulatory and Compliance
- Claims/Calls/Quality
- Projects and Presentations
- Training and Development
- Adaptable and Flexible
- Microsoft Proficient
Accomplishments
2012 Best of the Best Educator Award
- For excellence in classroom instruction
Timeline
Benefits Advocate
CNO Financial
07.2022 - 04.2023
Healthcare and Coding Instructor
UEI College
11.2010 - 08.2013
Medicare Operations Supervisor
Aetna Health Plans
06.2000 - 12.2008
Business Information Specialist
Aetna Health Plans
04.1999 - 06.2000
Claims Benefit Analyst
Aetna Health Plans
06.1995 - 03.1999
Bachelor of Science - Sociology
Arizona State University
Associate of Arts - Sociology
Fresno City College
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