Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Karina Santana

New York,NY

Summary

Quality assurance professional with extensive background in ensuring compliance with industry standards and regulations. Strong focus on team collaboration and achieving results. Dependable and adaptable, skilled in identifying issues and implementing effective solutions. Proven ability in quality control, process improvement, and documentation management, with keen eye for detail.

Overview

7
7
years of professional experience

Work History

Quality Assurance Administrator

VNS Health
02.2024 - 04.2025
  • Monitors and evaluates authorization data to ensure accuracy and compliance regulations are met. Assists management in developing performance improvement programs for staff.
  • Audited authorization records, identified discrepancies, and facilitated corrective actions.
  • Collaborates with cross-functional teams to ensure consistent quality standards throughout the entire development lifecycle.
  • Facilitates effective department operations by maintaining a strong working relationship and fostering communication among all staff and management.
  • Meets regularly with the management team to ensure that the quality program is running effectively and addresses any gaps that may exist.
  • Investigates and assists with regulatory inquiries. Reviews, analyzes and problem solves routine and complex
    situations.

Senior Transitional Care Assistant

VNS Health
07.2023 - 02.2024
  • Manages and prioritizes the list of "hospitalized" or "service interrupted" patients to ensure timely follow-up assessments.
  • Establishes and promotes an ongoing collaborative relationship with direct caregivers, hospital administration,physicians, nurses, discharge planners, case managers, social workers, unit clerks, homecare agencies and other facility personnel.
  • Notifies the appropriate hospital or physician staff when patient is having difficulty following the transitional care program; helps to identify and remove barriers to goal attainment, and assists with intervention as needed.
  • Follows up with patients and maintains expected timeframes as per workflow.

Authorization Coordinator

VNS Health
10.2018 - 07.2023
  • Learned and adapted quickly to new technology and software applications
  • Cultivated interpersonal skills by building positive relationships with others
  • Efficiently manage 50+ urgent emails daily using Outlook, responding to providers, care management, and internal departments regarding member authorizations, service issues, data entry errors, and cross-departmental troubleshooting; utilize internal systems (e.g., Altruista Guiding Care, HHAX, Salesforce) to track and resolve inquiries promptly.
  • Efficiently manage the creation, review, and modification of authorizations to promptly resolve discrepancies and ensure seamless member services.
  • Maintain detailed records of all communications through email and internal systems.
  • Managed and resolved complex internal and external system escalations for providers.

Care Management Support Coordinator

Visiting Nurse Services Of New York
03.2018 - 10.2018
  • Assist in non- clinical customer service with the care management department
  • Support in providing inquiry and reports on related activities.
  • Aiding in the resolution pertaining discrepancies which are related to the member
  • Informing the member and families about the programs and services that are offered along with healthcare professionals
  • Developed and updated policies and procedures, maintaining compliance with guidelines relating to
  • HIPAA, benefits administration and general liability
  • Translated communication between clinical staff and members

Education

High School Diploma -

High School For Law And Public Service
New York, NY

Skills

  • Healthcare Operations
  • Interdepartmental Collaboration
  • Utilization Management
  • Documentation
  • HIPAA Compliance
  • Quality assurance background
  • Internal audits

Languages

Spanish
Professional Working

Timeline

Quality Assurance Administrator

VNS Health
02.2024 - 04.2025

Senior Transitional Care Assistant

VNS Health
07.2023 - 02.2024

Authorization Coordinator

VNS Health
10.2018 - 07.2023

Care Management Support Coordinator

Visiting Nurse Services Of New York
03.2018 - 10.2018

High School Diploma -

High School For Law And Public Service

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Karina Santana