Summary
Overview
Work History
Education
Skills
Awards
Certification
Timeline
Generic

Franco Velasquez

Rialto,CA

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Business Analyst position. Ready to help team achieve company goals.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Utilization Review Lead

Prime Healthcare
09.2023 - Current
  • Streamlined data entry processes, ensuring timely submission of all required documentation for utilization review activities.
  • Contributed to efficient department operations by maintaining organized files and record-keeping systems for easy access and retrieval.
  • Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.
  • Supervised and maintained all utilization review documentation through Epic.
  • Provide daily task for team members working under my supervision to complete.
  • Cooperate with Sr. Billing collectors on the status of various patient accounts regarding claim status or decision for our claim appeals.
  • Upheld HIPAA regulations and standards for protecting patient information.
  • Give suggestion to executives on how we can make our team become more efficient and finish task in a timely manner.
  • Skilled at working independently and collaboratively in a team environment.
  • Self-motivated, with a strong sense of personal responsibility.

UTILIZATION REVIEW TECH III

Prime Healthcare
09.2022 - 09.2023
  • Coordinate and audit Utilization Reviews and appeals using Epic software
  • Collaborate with a team to enter medical data, coordinate phone calls with insurance providers, and mail denied insurance provider appeals
  • Follow up with documentation from insurance providers and health plans throughout the United States and submit Medical documents to the EPIC software
  • Communicate regularly with case management managers to discuss denial of patients medical bills by insurance provider
  • Train new hires how to coordinate the utilization review and appeals process as part of the denial management initiatives
  • Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool
  • Enhanced communication between healthcare providers and insurance companies by facilitating the exchange of critical information in a timely manner.
  • Strengthened relationships with external partners like insurance companies through proactive communication about authorizations, denials, appeals, or other related issues.
  • Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.

REMODELING ASSOCIATE

R & T Maintenance Services Corp
06.2021 - 06.2022
  • Performed a variety of tasks related to maintaining and renovating homes
  • Followed established job site safety regulations to maintain a safe and clean work environment
  • Removed all existing carpet and prepared installation surface for new flooring
  • Used hand tools and caulking gun to apply caulk to ensure a smooth and uniform finish and improve lifespan of installation
  • Operated a pressure washer to clean and maintain the appearance of all outdoor and decking patios
  • Enhanced customer satisfaction by completing remodeling projects on time and within budget.
  • Streamlined project timelines for improved efficiency with strong organizational skills and attention to detail.

MAINTENANCE ATTENDANT

Hampton Inn
06.2016 - 08.2016
  • Ensured a well maintained hotel grounds and facilities by ensuring properly disinfecting and cleaning
  • Ensured all emergency systems, such as fire alarms were fully functional according to state code
  • Document all emergency system checks and updates
  • Maintained HVAC systems daily
  • Complete minor structural repairs to bathroom facilities, hotel rooms and all hotel community areas
  • Received team award for outstanding QA inspection
  • Reduced downtime for essential systems by completing preventive maintenance tasks in a timely manner.
  • Improved equipment reliability by conducting regular maintenance checks and repairs.

Education

MBA - Business Analytics

Eastern University
St Davids, PA
09.2024

BACHELORS OF SCIENCE IN LIBERAL ARTS -

Frostburg State University
05.2021

Skills

  • Microsoft Programs and Google Drive
  • Able to productively contribute to a part of a team to solve any situation given
  • MEDITECH EHR Software
  • Able to grasp new concepts quickly and adapt to new environments
  • Able to multitask and create a plan of action to improve certain situations
  • Confident, articulate and professional communication with years of experience
  • Certified in Cardiopulmonary resuscitation (CPR)
  • Frequently practice active listening and empathy
  • Analytical Thinking

Awards

Earned three varsity letters in baseball at Felix Varela High School. All-Florida Region Honorable Mention for 2015 NJCAA Region XX D-II champion and NJCAA Northeast District champion 2018 Most valuable pitcher award in 2017 at Community College of Baltimore County Most valuable pitcher in 2021 at Frostburg State University.

Certification

Marketing Management Simternship Certification-December 9, 2023

Timeline

Utilization Review Lead

Prime Healthcare
09.2023 - Current

UTILIZATION REVIEW TECH III

Prime Healthcare
09.2022 - 09.2023

REMODELING ASSOCIATE

R & T Maintenance Services Corp
06.2021 - 06.2022

MAINTENANCE ATTENDANT

Hampton Inn
06.2016 - 08.2016

MBA - Business Analytics

Eastern University

BACHELORS OF SCIENCE IN LIBERAL ARTS -

Frostburg State University

Similar Profiles

CREATE PROFILE
Franco Velasquez