Joaquin Sebastian Leido
Gilbert,AZ
Summary
Driven Project Leader looking to bring talent and expertise to an exciting company. Easily able to plan, organize, control and monitor projects using appropriate techniques and tools. Adept at scheduling and risk management.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Consultant
Emids
09.2022 - Current
- Improved client satisfaction by effectively managing multiple projects and consistently meeting deadlines.
- Streamlined internal processes to enhance team efficiency and improve overall project outcomes.
- Collaborated with cross-functional teams to successfully deliver comprehensive solutions for clients.
- Utilized SQL management studio and Teradata to generate data for reporting purposes, identify trends and opportunities for process improvements within client organizations.
- Worked closely with vendors and internal stakeholders to coordinate data migration activities and resolve any issues.
- Responsible for reviewing Provider amendments and ensure that provider records and rates are loaded in QNXT in a timely manner.
- Acted as a key resource and subject matter expert for QNXT.
Manager, Informatics - QNXT Configuration
Aetna, CVS Health
02.2022 - 09.2022
- Analyzed Business Needs and determine if requirements can be implemented via QNXT custom editing.
- Worked on multiple projects on successfully improving QNXT Auto Adjudication.
- Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals.
Project Lead - QNXT Implementations
Aetna, CVS Health
05.2020 - 02.2022
- Successfully led implementation of Medicare and Medicaid (dual) plans in the QNXT Platform
- Provided team with coaching and direction with QNXT configuration designs
- Monitored progress and examined risks of various projects, including setting forth contingency plans.
QNXT Benefit Configuration Analyst
Molina Healthcare Inc
11.2019 - 05.2020
- Responsible for monitoring claims to ensure that the product met expectations based on Medicare requirements
- Implemented/Maintained Benefit properties in QNXT to ensure that the system is in compliance with CMS requirements
- Coordinated with systems partners to finalize designs and confirm requirements
- Provided management with daily reports for benefit related trends and issues
Project Lead
Aetna Medicaid Administrators LLC
09.2017 - 11.2019
- Successfully led implementation of new Medicaid plans in the QNXT Platform.
- Provided team with coaching and direction.
- Monitored QNXT performance and provided statistical reports for both real-time and historical measurements.
- Collaborated with clients and partners from concept through final delivery of product or service.
- Developed and implemented complex configuration build in the QNXT platform.
- Consistently met deadlines and requirements for all production work orders.
Application Support Analyst
Aetna Medicaid Administrators LLC
05.2016 - 09.2017
- Implemented Fee Schedule rates, Provider Contracts and Member Benefits in QNXT
- Experienced with Building the system organizational structure and aligning memberships within QNXT
- Used SQL to Pull live data from different tables for analysis
- Responsible for Analyzing and monitoring live claims to ensure that the product met expectations
Associate Testing Analyst
Aetna Medicaid Administrators LLC
12.2014 - 05.2016
- Responsible for initially identifying and subsequently defining the required tests
- Responsible for monitoring the test coverage and evaluating the overall quality experienced when testing the payment configuration system (QNXT)
- Lead End to End testing for new plan implementations
- Worked with SQL to query data in Dev/QA environments for testing purposes
Claims Benefit Specialist
Aetna Medicaid Administrators LLC
10.2013 - 12.2014
- Worked directly with peers and management to achieve excellent results.
- Processed claims for multiple health plans.
- Heavily involved with Pre check run reports and projects.
- Average Claims processed per Hour is 22.37 (Goal is 12/ Hr).
- Maintained a high accuracy score throughout my tenure.
Customer Service Representative
Aetna Medicaid Administrators LLC
04.2012 - 10.2013
- Provided excellent customer care by responding to requests, assisting with Medical Claims questions.
- Applied highly effective problem solving skills while properly engaging and presenting solutions to Medical Providers.
- Worked on multiple projects with management to propose and implement proactive customer service solutions such as publishing Call directories and workflows. .
- Maintained strong reputation of efficiency and accuracy, earning numerous recommendations from satisfied customers.
Data Entry Operator
Aetna Medicaid Administrators LLC
10.2011 - 04.2012
- Completed data entry tasks with accuracy and efficiency.
- Verified the accuracy of data before transcribing.
- Produced monthly reports using advanced Excel spreadsheet functions.
- Executed data verification to detect errors.
Education
Computer Information Systems
Maricopa Community Colleges - Mesa Community College
Mesa, AZRadiology
World Citi Colleges
Manila, PhilippinesHigh School Diploma - undefined
St Stanislaus Kostka
Manila, Philippines2007
Skills
- Mentoring and coaching
- Risk management skills
- Team leadership
- Project planning
- Organization skills
- Customer service
- SQL Proficient
- Microsoft Office Proficient
- MacOS proficient
- QNXT expert on system configuration
- Team Player
- Fast Learner
Certification
- Certified Six Sigma Yellow Belt
- Advanced Benefit Configuration Training (Trizetto)
- Introduction to Structured Query Language (Coursera - Credential ID CZ3QHY7S5U7B)
Timeline
Consultant
Emids
09.2022 - Current
Manager, Informatics - QNXT Configuration
Aetna, CVS Health
02.2022 - 09.2022
Project Lead - QNXT Implementations
Aetna, CVS Health
05.2020 - 02.2022
QNXT Benefit Configuration Analyst
Molina Healthcare Inc
11.2019 - 05.2020
Project Lead
Aetna Medicaid Administrators LLC
09.2017 - 11.2019
Application Support Analyst
Aetna Medicaid Administrators LLC
05.2016 - 09.2017
Associate Testing Analyst
Aetna Medicaid Administrators LLC
12.2014 - 05.2016
Claims Benefit Specialist
Aetna Medicaid Administrators LLC
10.2013 - 12.2014
Customer Service Representative
Aetna Medicaid Administrators LLC
04.2012 - 10.2013
Data Entry Operator
Aetna Medicaid Administrators LLC
10.2011 - 04.2012
Computer Information Systems
Maricopa Community Colleges - Mesa Community College
Radiology
World Citi Colleges
High School Diploma - undefined
St Stanislaus Kostka
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