Genesis Espinosa Vazquez
Orlando
Summary
Healthcare Administration Master's graduate with 5+ years in health insurance, specializing in Encounter Data Management. Proven in optimizing data processes, ensuring compliance, and boosting operational efficiency. Strategic thinker with strong analytical and communication skills, fluent in English and Spanish. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
8
8
years of professional experience
Work History
Encounter Data Management Professional 1
Humana
07.2022 - Current
- Ensure data integrity for claims errors, specializing in Medicare and Medicaid encounters
- Identify complex errors and problems within the encounter process using data analysis and claims research
- Collaborate with CMS and Duals Medicaid to improve encounter submission compliance
- Develop strategies and processes to decrease errors from CMS and Medicaid trading partners
- Partner with departments to highlight impacts and drive change, making decisions on work priorities
- Conducted process improvements and analyzed data using SQL and Excel for daily reports and CMS corrections.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
Claims Review Representative 3 Prepay Audit
Humana
03.2020 - 07.2022
- Reviewed and processed claims for prepay and post-pay departments
- Analyzed claims for compliance with company policies and guidelines
- Utilized CAS, CGX, Financial Recovery Enterprise, Ehub system, and other tools
- Achieved financial metrics of 99% accuracy and 97% procedural accuracy
- Identified opportunities for process improvements, meeting deadlines consistently.
Claims Research and Resolution Representative
Humana
12.2018 - 03.2020
- Processed 2,620,148 claims with an average financial result of 99.85%
- Met department metrics for quality financial (99%), payment (98%), and processing (97%)
- Processed 35 claims per hour and adjudicated complex or specialty claims
- Collaborated with insurance companies, providers, members, and collection services
- Led a group researching resolutions to pending calls.
Office Manager
Puerto Rico Sotheby's International Realty
02.2016 - 12.2018
- Implemented workflow processes to optimize personnel performance
- Coordinated meetings, prepared materials, and distributed clear notes
- Managed office operations, scheduled appointments, and oversaw inventory and transactions.
Education
Graduate Certificate - Health Informatics and Data Analytics
University of Denver
Master's - Health Administration
University of Phoenix
10.2022
Bachelor's - Public Health, Health Services Management
Turabo University
01.2019
Skills
- Process Optimization
- Risk Management
- Compliance Reporting
- Database Management
- Healthcare Operations
- Leadership Techniques
- Microsoft Office (Excel, Word, PowerPoint, Publisher)
- Data Analytics (SQL, SAS, Datamart)
Timeline
Encounter Data Management Professional 1
Humana
07.2022 - Current
Claims Review Representative 3 Prepay Audit
Humana
03.2020 - 07.2022
Claims Research and Resolution Representative
Humana
12.2018 - 03.2020
Office Manager
Puerto Rico Sotheby's International Realty
02.2016 - 12.2018
Graduate Certificate - Health Informatics and Data Analytics
University of Denver
Master's - Health Administration
University of Phoenix
Bachelor's - Public Health, Health Services Management
Turabo University
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