Open To Work
Esmeralda M. Delucca
Daytona Beach,FL
Summary
Extensive experience in healthcare analytics, reimbursement, and contract management. Strong foundation in provider relations, pricing strategies, and compliance a valuable combination in today’s healthcare landscape.
Comprehensive background in pricing analysis and strategy development. Successfully streamlined pricing models and contributed to revenue growth through targeted pricing initiatives. Demonstrated analytical proficiency and strong attention to detail in complex data analysis and cross-functional collaboration.
Overview
31
31
years of professional experience
1
1
Certificate
Work History
Senior Pricing Analyst
UnitedHealthcare
09.2001 - 08.2021
- Performed Hawaii and Arizona’s state website research for the Community and State business. Assessing and interpreting customer needs and requirements, identifying solutions to requests and/or problems. Solved moderately to complex issues and/or conduct moderately complex analysis. Coached, provided feedback, and guidance for peers with less experience. Ensured that the Market Standard Fee Schedules load activities were completed accurately and in a timely manner.
- Identified and formulated recommendations for system issues and worked with Network Account Managers/Senior Network Account Managers to determine the appropriate corrective action plan and coordinate resolution. Acts as a liaison to Provider Reimbursement Operations & Solutions (PROS), Network Management and Corporate resources dedicated to Market Standard Fee Schedule maintenance pertaining to Hawaii and/or Arizona (New, Modifications, and Expires). Provided subject matter expertise and business knowledge to ensure Network Market Fee Schedules are requested to support the strategy.
- Developed programs, policies, and strategies to ensure that contracted rates are applied accurately. Analyzed claims, pre and post payment, to ensure contracts are priced accurately. Reviewed claim disputes to verify correct pricing and analyzed claim inquiry data to determine root cause of errors; recommended system changes training and process improvements to prevent future errors. Researched and resolved provider related contract system configuration issues. Completed back-end audits on market standards responsible for markets.
- Investigated and evaluated activities performed by PCRL collaborates with PROS to identify potential load issues and recommend corrections. Prepare and submit contract briefs for complex arrangements and Fee Schedules, as necessary. Worked with customers and peers to identify and resolve complex problems, serving as a leader and resource to the team.
Caregiver
Florida Community Care Medicaid
02.2021 - 09.2025
- Provided compassionate personal care, ensuring comfort and dignity for clients.
- Assisted clients with daily living activities, fostering independence and enhancing quality of life.
- Monitored client health conditions, reporting changes to healthcare professionals promptly.
- Developed personalized care plans in collaboration with families and healthcare providers.
- Coordinated schedules for multiple clients, optimizing time management and service delivery efficiency.
Senior Consultant
Hospital Resource Management
01.2000 - 07.2001
- Formulated and maintained hospital’s Charge Master Database (CMD) to optimize revenue generation, maintain compliance with third-party payer requirements, generate management reports on resource utilization, and associated topics. Studied, reported, and made recommendations regarding compliance concerns. Directed the CMD review team in its periodic comprehensive reviews and ongoing refinement. Teamed and worked with personnel involved in setting up or reengineering departments, service areas, and service lines as they affect development of or changes to the CMD.
Rate Coordinator
Parkland Health & Hospital System
02.1995 - 12.1999
- Prepared Charge Master Database (CMD) analysis and financial forecasts for senior management. Maintained the Charge Master Database (CMD) of all new modifications, and/or deletions to adhere Medicare and Medicaid state guidelines.
- Managed the review of internal pricing and coding structures for more than 150 revenue centers, in compliance with Medicare and Medicaid’s manual guidelines. Coordinated, monitored, and approved all changes made to the CMD Referenced to the UB-92 Editor for guide to accurate UB-92 submissions.
Education
Diploma -
Business Management Center H.S.
Skills
- Expert level in physician reimbursement, claims, policy payment, and/or coding methodologies including Centers for Medicare & Medicaid Services (CMS)
- Expert knowledge of the functions and activities of hospitals, medical clinics, and manage care with emphasis on finance/government reimbursement
- Healthcare claims processing systems UNET, COSMOS, and CSP Facets, EPIC experience
- Ability to participate with upper management in a decision support mode through the development of appropriate management information
- Compliance issues and their importance; can be relied upon to act ethically, to safeguard confidential information and to adhere to company’s Code of Conduct and all legal and regulatory requirements
- Work effectively with and coordinate the activities of outside consultants
- High level of work quality, focused on detail, and is dependable in meeting commitments and fulfilling obligations
- Skill in using personal computers for financial analysis utilizing Microsoft Office
- Skill in using personal computers for electronic mail communication, eg Cisco Jabber, Novell Group Wise, Microsoft Outlook
- Ability to effectively multitask, effectively managing multiple projects and initiatives
- Skill in networking with colleagues and professional organizations and the ability to utilize networking capabilities through Internet newsgroups and list servers
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Work excellent under pressure deadlines without sacrificing accuracy, quality, customer service, collegiality and ethics
- Bilingual (fluent in Spanish)
- Integrity, respectful and compassionate individual
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Certification
St. Anthony's Mastering Chargemasters
Timeline
Caregiver
Florida Community Care Medicaid
02.2021 - 09.2025
Senior Pricing Analyst
UnitedHealthcare
09.2001 - 08.2021
Senior Consultant
Hospital Resource Management
01.2000 - 07.2001
Rate Coordinator
Parkland Health & Hospital System
02.1995 - 12.1999
Diploma -
Business Management Center H.S.
Work Preference
Job Search Status
Open to workDesired start date: Immediately
Desired Job Title
Senior Pricing AnalystSenior Contract AnalystReimbursement AnalystRevenue Cycle SpecialistBusiness AnalystWork Type
Full TimePart TimeContract WorkGig WorkConsultingVolunteerSeasonal WorkLocation Preference
On-SiteRemoteHybridLocation: Daytona Beach, FL, US
Open to relocation: No
Salary Range
$55000/yr - $100000/yrSimilar Profiles
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