Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
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Ivonne Cobas

Miami,FL

Summary

Performance-driven Vice President with many years of experience aligning systems with business requirements, policies and regulatory requirements. Passionate about applying excellent organization and communication skills to manage and lead teams. Results-oriented individual well-versed in interfacing and consulting on business processes to drive results based on sound overall business judgment.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Vice President of Quality and Risk

Femwell Group Health
08.2022 - Current
  • In conjunction with the other senior leaders, I help plan the strategic direction and organization of Risk Adjustments and Value Based initiatives for all products to facilitate achievement of the goals and objectives.
  • Ensure that performance targets are set and clearly communicated. Assess the Value Based Team's performance against goals and objectives.
  • Meet compliance with administrative and legal requirements concerning Value Based data submissions.
  • Proactively monitor changes to membership rosters, and other system implementations to ensure Value Based needs are voiced and considered. Communicate changes to stakeholders in advance of the change where possible.
  • Help create financial forecasting and variance analyses relating to Medicare, Medicaid and Marketplace Value Based programs.
  • Collaborate with other members of the senior leadership team to prioritize management reporting and information to focus on those areas that have the greatest impact on decisions.
  • Serve as liaison with Accounting, Finance, Medicare, Medicaid and Marketplace Programs, National Compliance, Legal, and other related departments.
  • Help build and maintains collaborative partnerships with Plan Presidents and Regional Vice Presidents in order to enhance the success of Value Based initiatives nationally and at the state level.

Senior Director of Quality & Risk Adjustment

Femwell Group Health
10.2021 - 08.2022
  • Directed design and execution of business transformation initiatives to drive performance, profit optimization and growth opportunities.
  • Helped optimize performance measures for all Value Based programs.
  • Worked in conjunction with senior leadership to initiate the Triple Aim pillars to the organization.
  • Fostered work culture of collaboration and inclusion to increase morale and reduce turnover.
  • Drove strategic improvements to enhance operational and organizational efficiencies.
  • Led development of business operation processes and policies for Value Based and Risk Adjustment programs.

Director of Quality Assurance

Femwell Group Health
08.2017 - 10.2021
  • Reviewed and analyzed quality measures and chart audit reports, records and directives.
  • Managed the auditing staff by monitoring the functional area, providing guidance and leadership, developing methods of improvement, assure the work schedules are maintained and that productivity requirements are met.
  • Supervise and periodically review the accuracy of MRA documentation and billing
  • Provides a monthly briefing to the Director of Compliance and Quality Assurance, ensuring all outstanding issues are communicated
  • Set training and coaching plan for Corporate and physicians
  • Ensured coding policies and procedures were monitored and updated to include contractual changes, and communicate any non-compliance to the Corporate Compliance and Quality Assurance Officer as well as other appropriate parties
  • Utilized the results from quality assessment activities to improve processes that affect patient care outcomes, improve quality star ratings, and RAF scores

Quality Assurance Coding Manager

Femwell Group Health
08.2014 - 08.2017
  • Evaluated team and updated training curriculum based on feedback.
  • Participated in hiring and training coding team.
  • Performed coding quality reviews and tracked, trended and managed coding quality performance.
  • Conducted credible research to supply current, relevant, reliable and factual detail.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.

Quality Assurance Medical Chart Auditor

Femwell Group Health
08.2009 - 08.2014
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Audited chart information collected verifying guidelines from the following organizations; ACOG, CMS, CPT, ICD and AMA. Recorded findings and data into computer programs and filing systems.
  • Communicated effectively with physicians, office managers, and insurance companies by email, telephone, and face to face meetings.
  • Maintained accuracy, completeness, and security for medical records and health information.

Education

Bachelor of Science - Healthcare Administration

Florida International University
Miami, FL
06.2016

Skills

  • Data Analysis
  • Operations Management
  • Revenue Cycle Management
  • Client Relationship Building
  • Staff Development
  • Risk Management
  • Metrics Tracking
  • Process Improvement
  • Policy and Procedure Development
  • Team Leadership
  • Customer Education
  • Presentations

Certification

AAPC Certifications: CPC, CRC, COBGC, CPMA

Languages

Spanish
Native or Bilingual

Timeline

Vice President of Quality and Risk

Femwell Group Health
08.2022 - Current

Senior Director of Quality & Risk Adjustment

Femwell Group Health
10.2021 - 08.2022

Director of Quality Assurance

Femwell Group Health
08.2017 - 10.2021

Quality Assurance Coding Manager

Femwell Group Health
08.2014 - 08.2017

Quality Assurance Medical Chart Auditor

Femwell Group Health
08.2009 - 08.2014

Bachelor of Science - Healthcare Administration

Florida International University

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Ivonne Cobas