Humberto Arredondo
Mesa,AZ
Summary
Experienced Quality Auditor with well-honed analytical skills with regulatory compliance auditing experience for 3 years. Solution-focused professional highly-regarded among peers and supervisors in health industry. Skilled auditor who works diligently with all levels of peers, management and external authorities.
Overview
16
16
years of professional experience
Work History
Senior Quality Assurance Auditor
Bright Health
06.2022 - Current
- Gathered and reviewed current data to determine areas in need of improvement.
- Completed timely quality reports highlighting deficiencies and recommending corrective actions.
- Determined correct procedures to standardized audit processes.
- Executed monthly audits of various departments.
- Was crucial in the implementation of quality internally and with our Vendors for our Provider Services Department.
- Was crucial in the implementation of quality with our Vendors for our Utilization Management Department.
- Scheduled and led quality assurance calibrations for two respective departments.
- Collaborated in creating/establishing a Quality Inspection Guide for Bright Health.
- Trained and calibrated peers to be in alignment with our quality guide.
- Trained and calibrated our partnered Vendors to be in alignment with our quality guide.
- Assisted Supervisors in providing them feedback for their 1:1 coaching sessions.
- Took on miscellaneous special projects and executed each one with ease. Misc projects included reviewing partnered Vendor calls as well as specific plan calls and provided feedback to leadership for improvements.
- Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Developed customized reports, summarizing and presenting data in visually appealing format.
- Generated standard and custom reports to provide insights into business performance.
- Utilized data visualization techniques to present and explain complex data sets.
- Identified patterns and trends in large data sets and provided actionable insights.
Quality Assurance Auditor
Bright Health
11.2021 - 06.2022
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork.
- Audit representative inbound calls to ensure quality.
- Mentored and coached team members on QA topics and strategies.
- Organized and maintained work environment to allow for maximum productivity.
- Fixed identified issues to increase productivity and boost workflows.
- Developed reports and materials for Management related to quality goals, progress and challenges.
Revenue Integrity Lead
Falck
01.2019 - 11.2021
- Create and distribute excel reports to my team to work various projects
- Oversee the monitoring of my team to ensure everyone is working diligently and taking lunch/breaks on time
- Work patient inquiries received via email
- Process manual payments using online systems
- Received and worked checks by mail for patient accounts
- Work in cohesion with various billing offices to ensure satisfaction of accounts based on area
- Answer escalated calls and assist patients with their disputes
- Work any miscellaneous reports received by upper management
- Sort mail and distribute to the team accordingly based on role.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Monitored outstanding invoices and performed collections duties.
Collection Specialist/Customer Service
Falck
01.2014 - 01.2019
- Answered inbound calls as well as made outbound calls to patients to collect debt
- Received and verified insurance information online to ensure proper billing
- Processed payments over the phone with patients to either set up payment arrangements or process balance in full
- Worked in a high call volume environment taking back to back calls efficiently
- Used proper de-escalation methods to avoid supervisor calls with disgruntled patients
- Worked excel type spreadsheets for special reports provided by management
- Worked alongside management to provide the call center with games to boost morale.
- Used skip tracing and other techniques to locate debtors.
Collections Specialist/Customer Service
Rural Metro Ambulance
01.2013 - 01.2014
- Answered inbound calls as well as made outbound calls to patients to collect debt
- Received and verified insurance information online to ensure proper billing
- Processed payments over the phone with patients to either set up payment arrangements or process balance in full
- Worked in a high call volume environment taking back to back calls efficiently
- Use proper de-escalation methods to avoid supervisor calls with disgruntled patients.
Shift Manager
Einstein Bagels
01.2011 - 01.2013
- Answered customers' questions and addressed problems and complaints in person and via phone
- Opened and closed the store, which included counting cash drawers and making bank deposits
- Maintained visually appealing and effective displays for the entire store
- Educated customers on product and service offerings
- Offered exceptional customer service to differentiate and promote the company brand
- Kept the showroom clean and maintained neat, orderly product displays
- Built customer confidence by actively listening to their concerns and giving appropriate feedback
- Communicated merchandise needs and issues to appropriate supervisors in a timely fashion
- Balanced the needs of multiple customers simultaneously in a fast-paced retail environment
- Communicated store policy violations to the leadership team in a timely manner
- Offered direction and gave constructive feedback to motivate team members
- Held each team member accountable for achieving brand and performance goals
- Built and maintained effective relationships with peers and upper management
- Processed all sales transactions accurately and in a timely fashion.
Market Researcher
Market Solutions Group
01.2009 - 01.2011
- Collected customer feedback and made process changes to exceed customer satisfaction goals
- Provided accurate and appropriate information in response to customer inquiries
- Demonstrated mastery of customer service call script within specified time frames
- Addressed customer service inquiries in a timely and accurate fashion
- Worked with upper management to ensure appropriate changes were made to improve customer satisfaction
- Provided cross training to 3 staff members
- Trained staff on how to improve customer interactions
- Assisted with the development of the call center's operations, quality, and training processes.
Waiter/Restaurant Manager
David's Hamburgers And Mexican Food
01.2008 - 01.2009
- Promoted positive atmosphere and went above and beyond to guarantee each customer received exceptional food and service.
- Carefully interviewed, selected, trained, and supervised staff.
- Led and directed team members on effective methods, operations, and procedures.
- Tracked daily sales transactions and invoices for accurate and updated financial reporting.
- Reconciled cash and credit card transactions to maintain accurate records.
- Quickly identified problem situations and skillfully resolved incidents to satisfaction of involved parties.
- Kept facility compliant with health codes, sanitation requirements and license regulations, alleviating potentially heavy fines.
- Reduced inaccuracies by carefully counting cash and keeping meticulous records of transactions.
Education
No Degree - Scottsdale
Maricopa Community Colleges - Scottsdale Community College
Scottsdale, AZHigh scool degree -
Saguaro High School
Scottsdale, AZ2010
Skills
- Bilingual: Fluent in Spanish
- Staff Oversight and Leadership
- Quality Assurance Training
- Quality Assurance Procedures
- Process Implementation
- Critical Thinking and Analysis
- Microsoft Excel
- Microsoft Word
- Microsoft Outlook
- People person
- Organized
Timeline
Senior Quality Assurance Auditor
Bright Health
06.2022 - Current
Quality Assurance Auditor
Bright Health
11.2021 - 06.2022
Revenue Integrity Lead
Falck
01.2019 - 11.2021
Collection Specialist/Customer Service
Falck
01.2014 - 01.2019
Collections Specialist/Customer Service
Rural Metro Ambulance
01.2013 - 01.2014
Shift Manager
Einstein Bagels
01.2011 - 01.2013
Market Researcher
Market Solutions Group
01.2009 - 01.2011
Waiter/Restaurant Manager
David's Hamburgers And Mexican Food
01.2008 - 01.2009
No Degree - Scottsdale
Maricopa Community Colleges - Scottsdale Community College
High scool degree -
Saguaro High School
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