Nelsigleny Lopez
Orlando,FL
Summary
Well-qualified Foreign Dentist with FL Dental Hygienist license, versatile, high-energy, results-oriented, proficient in best practices and with 6+ year experience in managed care organization.
Overview
20
20
years of professional experience
Work History
Manager of Clinical Analytics
MCNA Dental
11.2019 - Current
- Developed and deployed clinical criteria content to improve clinical review consistence
- Monitored and evaluated underutilization of preventive services to identify trends and opportunities for improvement
- Designed and conducted Inter-rater reliability to clinical team
- Conducted market research and competitor analysis to present strategies
Clinical Review Analyst
MCNA Dental
07.2018 - 11.2019
- Analyzed and monitored dental utilization and recommended improvement strategies.
- Proven ability to learn quickly and adapt to new situations.
- Worked effectively in fast-paced environments.
Dental Record Reviewer
MCNA Dental
01.2017 - 07.2018
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations
- Reviewed dental records and flagged incomplete or inaccurate information
- Analyzed complex dental records to identify discrepancies in accuracy and completeness
Dental Hygienist
Weston Family Dental
11.2015 - 01.2017
- Screened patients for signs of oral cancer, lesions, or disease by visually and manually inspecting mouth and gums
- Educated patients on importance of oral hygiene and demonstrated techniques for flossing and brushing
- Maintained accurate medical and dental records by documenting important patient data
Dental Hygienist
Tamarac Family Dental
07.2014 - 10.2016
- Carried out advanced dental cleaning services
- Correctly administered local anesthetic and adjunctive therapies such as fluoride treatments and irrigation
- Educated patients on importance of oral hygiene and demonstrated techniques for flossing and brushing
Dental Assistant
Acadia Family Dental. FL
01.2013 - 06.2014
- Successfully assisted dentist by performing four-handed dentistry and other chair-side duties
- Performed general chair-side duties for general dentistry, endo procedures, and oral surgery
- Documented patient dental health information, medical history, and vital signs for future reference
Medical Records Staff
Living Water Care Center South
05.2011 - 02.2012
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations
- Uploaded physician progress notes, history, and physicals into electronic medical records
- Maintained accuracy, completeness, and security for medical records and health information
Forensic Dentist
Cuerpo de Investigaciones Científicas, Penales y Criminalísticas, CICPC
12.2003 - 11.2010
- Conducted thorough oral evaluations in order to identify human remains that cannot be identified using face recognition, fingerprints or other means.
- Checked growth, development and maxillary changes for verification of typical developmental milestones for age group
- Examination and evaluation of injuries to teeth, jaws, and oral tissues resulting from various causes (abuse, assault, mass disasters, and crime-related injuries)
Education
Dental Billing And Coding -
American Association of Professional Coders
2022
Emerging Leader Program -
United Healthcare
2022
The Seven MAC Quality Improvement Courses -
Medicaid And CHIP (MAC) Quality Improvement
2021
Dental Coder -
American Dental Coders Association
Peoria, AZ2021
Dental Hygiene Implant Certification -
ICOI
Miami, FL2016
Local Anesthesia Certificate -
Palm Beach State College
Florida2014
Dental Hygienist License -
Health Department
Florida 2014
Master's degree - Forensic Sciences & Criminalistics
Universidad Autónoma De Madrid
Spai2009
Bachelor of Science - Dentistry
Universidad Gran Mariscal De Ayacucho
Venezuela 2002
Skills
- Subject matter in current dental terminology (CDT) and proficient in ICD – 10 CM codes relevant to dentistry
- Knowledgeable of regulations established by Center for Medicare & Medicaid Services (CMS) and State Medicaid agencies
- Experience in clinical review - Inter-rater reliability -
- Quality Improvement - Dental record and quality audits
- Critical thinking and analytical skills oriented toward cost reduction and improve patient overall health
- In-depth healthcare knowledge with emphasis on utilization management and claims
- Ability to analyze and interpret State and Federal laws, rules, and regulations
- Competence to analyze data for patterns and trends in over/under utilization, and to investigate root causes of patient care trends
- Experience in quality performance improvement projects (PIPs)
- Expertise in Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and medical necessity reviews authorizations
- Peer reviewed clinical research to develop clinical documents
- Data analytics proficiency
Languages
Spanish
Native or Bilingual
Timeline
Manager of Clinical Analytics
MCNA Dental
11.2019 - Current
Clinical Review Analyst
MCNA Dental
07.2018 - 11.2019
Dental Record Reviewer
MCNA Dental
01.2017 - 07.2018
Dental Hygienist
Weston Family Dental
11.2015 - 01.2017
Dental Hygienist
Tamarac Family Dental
07.2014 - 10.2016
Dental Assistant
Acadia Family Dental. FL
01.2013 - 06.2014
Medical Records Staff
Living Water Care Center South
05.2011 - 02.2012
Forensic Dentist
Cuerpo de Investigaciones Científicas, Penales y Criminalísticas, CICPC
12.2003 - 11.2010
Dental Billing And Coding -
American Association of Professional Coders
Emerging Leader Program -
United Healthcare
The Seven MAC Quality Improvement Courses -
Medicaid And CHIP (MAC) Quality Improvement
Dental Coder -
American Dental Coders Association
Dental Hygiene Implant Certification -
ICOI
Local Anesthesia Certificate -
Palm Beach State College
Dental Hygienist License -
Health Department
Master's degree - Forensic Sciences & Criminalistics
Universidad Autónoma De Madrid
Bachelor of Science - Dentistry
Universidad Gran Mariscal De Ayacucho
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