Summary
Overview
Work History
Education
Skills
Timeline
Generic

ERIK SILVA

Phoenix,AZ

Summary

Healthcare professional with extensive experience in driving strategic improvements that enhance service delivery metrics. Demonstrated proficiency in analytical thinking and effective communication, contributing to success in high-pressure environments. Proven ability to implement solutions that yield measurable results and improve operational efficiency.

Overview

10
10
years of professional experience

Work History

Clinical Quality Audit Analyst

Oscar Health
01.2022 - Current
  • Performing regular English and Spanish audits of workflows, documentation, and transactions to ensure compliance with quality standards, regulatory requirements, and organizational policies.
  • Analyzing audit findings, trends, and patterns to identify root causes of quality issues, performance gaps, and areas for improvement, using statistical methods and data visualization tools as needed.
  • Providing training, guidance, and support to staff members on quality standards, audit processes, best practices, and compliance requirements to promote a culture of quality and continuous improvement.
  • Collaborating with various departments, teams across the organization, including Operations, Quality Training, etc., to ensure alignment of audit objectives and facilitate information sharing.

Provider Relations Specialist

Oscar Health
01.2019 - 01.2022
  • Responsible for the resolution of escalated provider issues that funnel through the escalation process.
  • Acted as a resource for other teammates, teams, serving as a Subject Matter Expert for specified markets and hospital networks.
  • Perform deep-dive analyses to identify root cause failures and develop remediation action plans for escalated provider issues.
  • Establish and build relationships with provider communities within the market by communicating issue resolution progress from start to finish, and by providing consistent updates on resolution plans.
  • Track, monitor, and provide status of multiple on-going projects within the markets and/or regions.
  • Manage and facilitate weekly cross department meetings, discussing trends, on-going issues, and or team updates.

Care Guide

Oscar Health
01.2018 - 01.2019
  • Responsibly and promptly answering incoming calls from members, caregivers, or healthcare professionals seeking assistance, information, or guidance.
  • Assessing the urgency of caller inquiries and directing them to appropriate resources, departments, or healthcare providers based on the nature of their concerns and level of urgency.
  • Documenting detailed and accurate information about caller interactions, including their inquiries, concerns, actions taken, and any follow-up required.
  • Escalating complex or critical issues to supervisors, healthcare professionals, or emergency services as necessary, following escalation procedures and ensuring timely resolution.

Health Aide

Tolleson Union High School District
Tolleson, AZ
08.2015 - 05.2017
  • Tracked health and well-being of students while documenting significant health changes.
  • Monitored diet plans of patients to ensure nutritional needs were met.
  • Maintained accurate documentation of student care services provided in medical records.
  • Collaborated with other healthcare professionals regarding individualized care plans for each student.
  • Documented patient care activities in electronic health records systems.

Education

Kent State University
Kent, OH

Skills

  • Audit compliance
  • Provider relations
  • Data analysis
  • Project planning
  • Quality assurance
  • Regulatory compliance
  • Training development
  • Employee training

Timeline

Clinical Quality Audit Analyst

Oscar Health
01.2022 - Current

Provider Relations Specialist

Oscar Health
01.2019 - 01.2022

Care Guide

Oscar Health
01.2018 - 01.2019

Health Aide

Tolleson Union High School District
08.2015 - 05.2017

Kent State University

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