Gabriel Vasquez
Sanford,FL
Summary
Program management specialist with a dynamic background who has demonstrated experience managing complex projects, increasing operational effectiveness, and strengthening cross-functional cooperation. proficiency in creating and executing procedures that guarantee adherence to legal requirements, enhance stakeholder communication, and optimize corporate operations. adept at overseeing several projects at once, with a strong emphasis on meeting strategic goals and producing excellent outcomes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Specialist - Network Business Operations and Program Management
Florida Blue
Lake Mary, FL
08.2022 - Current
- Played a key role in the establishment and execution of Florida Blue's cutting-edge Federal No Surprises Act (NSA) Independent Dispute Resolution (IDR) Process
- Educated and collaborated with multiple stakeholders (Network, Legal, Compliance, PIO, IT, BlueCard, Claims, FEP) to enhance the efficiency of the company's NSA IDR Process.
- Delivered comprehensive training on the IDR Process to newly onboarded employees
- Created IDR DTP as well as streamlined processes/flows for different states within the IDR lifecycle
- Collaborated with Network Analytics to enhance QPA and reimbursement methodologies for non-par provider schedules
- Engaged in professional development through attendance at CMS webinars and relevant work groups pertaining to NSA's functions
- Managed IDR Mailbox Inventory and conducted daily meetings to review and distribute IDR work effectively
- Coordinated communication efforts with IDR entities, Providers, and the Department of Labor to resolve NSA IDR challenges.
- Created and managed the IDR SharePoint Site, guaranteeing data integrity.
- Aided in the implementation and adoption of the new automated system (MAAGC) for IDR team through active participation in work groups.
Delivery Systems Coordinator
Florida Blue
Lake Mary, FL
04.2016 - 08.2022
- Compiled and managed inventory reports for Ancillary HBP Statewide and Central teams, ensuring accurate assignment and evaluation of requests.
- Implemented provider terminations and conducted audits to ensure compliance with organizational policies and regulations.
- Educated internal and external partners on contractual processes, medical policies, and reimbursement procedures, improving their understanding and performance.
- Led and participated in large-scale projects (e.g., Truli for Health, Turn the Map Green), ensuring effective resource utilization and adherence to project management standards.
- Analyzed data to identify trends and issues, informing business decisions and policy development.
Healthcare Data Analyst Contractor
Florida Blue
Lake Mary, FL
08.2012 - 04.2016
- Supported contracting initiatives by ensuring accurate network participation and timely contract processing.
- Conducted research and provided documentation for internal and external partners on provider contracts and terms.
- Managed Siebel requests, fostering collaboration with multiple stakeholders and ensuring contract compliance.
- Led efforts to reduce inventory and provided educational support for provider registration and maintenance.
- Compiled and presented detailed reports to senior management on inventory reductions.
Data Processor/Imager Contractor
Univita Health
Maitland, FL
01.2012 - 04.2012
- Generated Quality Assurance assessment letters and supported compliance reporting for senior management.
- Assisted with clerical tasks, including document scanning and inventory control, ensuring adherence to departmental guidelines.
- Managed company scanning equipment and maintained inventory control.
- Supported data processor mailbox and compliance requests within specific timelines.
Education
Business Management -
Seminole State College
Sanford, FL01.2012
High School Diploma -
Lake Brantley High School
01.2009
Skills
- Network Management
- Business Operations
- Partnership Development
- Communication
- Collaboration
- Relationship Building
- Liaison
- Interpretation
- Compliance
- Contractual Agreements
- Health Insurance Products
- Reimbursement Methodologies
- Business Processes
- Research Skills
- New Business Initiatives
- Documentation Management
- Organizational Skills
- Improvement plan knowledge
- Adaptability and Flexibility
- Task Prioritization
- Process Improvement
Affiliations
- Volunteering at Church with the Youth
- Involved with activates at my daughters school and after school activities.
Certification
- LCS White Belt June 25, 2021
References
References available upon request.
Timeline
Specialist - Network Business Operations and Program Management
Florida Blue
08.2022 - Current
Delivery Systems Coordinator
Florida Blue
04.2016 - 08.2022
Healthcare Data Analyst Contractor
Florida Blue
08.2012 - 04.2016
Data Processor/Imager Contractor
Univita Health
01.2012 - 04.2012
Business Management -
Seminole State College
High School Diploma -
Lake Brantley High School
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