Luis Pastukhov
Summary
Highly skilled Operations Manager with a strong background in strategic planning, implementation, process improvement, and team leadership. Demonstrates the ability to drive business growth through operational efficiencies and effective management. Excel in communication, problem-solving, and adaptability to drive improvement and achieve organizational goals. Brings strengths in financial oversight, cross-functional collaboration, and problem-solving. Implemented innovative solutions that enhanced overall business performance and profitability. Computer-literate in Microsoft Office, Facets, Power BI, SQL, Salesforce, healthcare claims, MS Dynamics, dashboards, and KPIs.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Manager of Business Operations
Partners Health Plan
New York
01.2019 - Current
- Experience supporting performance and process improvement projects to ensure deadlines are met, including completing root cause analyses, compiling improvement opportunities, documenting process flows, completing supporting analysis.
- Responsible for day-to-day operations of assigned business unit or product line ensuring product strategy developed and key priorities are implemented.
- Understanding of managed care models including HMO, PPO, Medicaid, Medicare Advantage, Duals, SNP, MLTC.
- Collaborate with multiple stakeholders and business unit leadership to establish strategic vision, operational objectives, and policies and procedures ensuring compliance with state and federal contracts, related laws, regulations and executive orders.
- Performs data research, investigation, and competitive analysis to evaluate business operations and implement processes and tools to improve efficiency and drive cost savings.
- Builds strategic partnerships with stakeholders, clients and vendors and collaborates cross functionally to align capabilities, and business priorities.
- Responsible for Grievance and Appeals, Call Center Monitoring, Durable Medical Equipment (DME), Quality Assurance, Annual Reporting and Enrollment.
- Monitoring high dollar claims and ensuring timely responses are provided to allow for timely claim adjudication.
- Experience working with large volumes of data within MS Excel spreadsheets to include utilizing vLookups; as well as creating and manipulating pivot tables.
- Extensive knowledge of Claims Systems Processes and payment integrity.
Senior Business Analyst
Fidelis Care NY
New York
01.2017 - 01.2019
- Responsible for creating data definitions, validating data, retrieving data from systems, merging data from multiple sources, participating in or reviewing technical documentation, report configuration, creating training materials, and coordinating project efforts as directed to achieve desired results.
- Leads project planning, scope of work, creative briefs, timelines, budgets, asset management and systems.
- Tracking call center reporting and reconciling data validation.
- Developed, processed, and implemented effective workflows in Microsoft Dynamics.
- Performing and executing all functional testing, developing test scripts, and translating these for usage in automated regression testing, including calculations and improvement of process.
- Developed understanding of business strategy, priorities, organizational structure and key performance indicators (KPIs).
- Collected, analyzed, and summarized data using SQL and other data mining tools to deliver information to customers, assist with recommendations.
- Worked collaboratively with financial analysis, sales, and marketing to develop market growth and retention plans to achieve membership objectives.
Business System Quality Assurance Analyst
CITIGROUP Inc.
Long Island City
01.2015 - 01.2017
- Analyzed, reported, and presented findings as well as create high quality visual representations for broad and diverse audiences within the organization.
- Created precise documents to describe specifications, capabilities, and processes associated with the assigned projects demonstrating efficiency and effectiveness.
- Manipulated data to identify variance and root cause, analyze trend, summarize findings and develop recommendations for stakeholder.
- Recommended actions for future development & strategic business opportunities, as well as enhancements to products and policies.
- Proficient knowledge of ICD9, CPT, HCPCS and DRG coding.
- Gathered operational data from various cross functional stakeholders to examine past business performance.
- Identified data patterns & trends, and provides insights to enhance business decision making capability in business planning, process improvement, solution assessment etc.
Education
MBA - Finance & Leadership
International MBA Institute
01.2022
B.S. - Business Management & Finance
CUNY Brooklyn College
Brooklyn, NY01.2017
B.B.A - Business Administration
CUNY Brooklyn College
Brooklyn, NY01.2017
Skills
- Claims processing
- Data analysis
- Process improvement
- Performance monitoring
- Regulatory compliance
- Strategic planning
- Stakeholder engagement
- Business operations
- Project management
- Cross-functional collaboration
- Strategic development
- Analytical skills
- Vendor management
- Business workflows
Certification
- Project Manager Certification, International Organization for Project Management, 01/01/25
- Scrum Team Member, International Scrum Institute, 01/01/22
Timeline
Manager of Business Operations
Partners Health Plan
01.2019 - Current
Senior Business Analyst
Fidelis Care NY
01.2017 - 01.2019
Business System Quality Assurance Analyst
CITIGROUP Inc.
01.2015 - 01.2017
MBA - Finance & Leadership
International MBA Institute
B.S. - Business Management & Finance
CUNY Brooklyn College
B.B.A - Business Administration
CUNY Brooklyn College