Nohelia Urena
Sunrise,USA
Summary
Digital consultant with strong expertise in driving impactful digital strategies and solutions. Known for effective team collaboration, adaptability to changing needs, and delivering measurable results. Skills include provider digital solutions, data analysis, and project management. Recognized for reliability, communication, and problem-solving abilities.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Senior Digital API Consultant/Business Consultant
UnitedHealthcare (PSO)
11.2021 - Current
- Led digital transformation initiatives to enhance provider business operations and improve efficiency.
- Collaborated with cross-functional teams to streamline processes and enhance the API adoption process.
- Built relationships with technology vendors, RCMs, and providers through API implementation process leading to effective implementation of digital solutions.
Associate Project Manager/Sr. Business Process Analyst
UnitedHealthcare (PDT)
10.2018 - 11.2021
- Led cross-functional collaboration projects with leadership, SMEs, and technical teams to identify and implement agile digital transformation initiatives.
- During COVID formed part of the task force that assisted with the agile transition of 300+ offshore employees to work from home.
- Managed project documentation, business requirements, SOPs, and proposals to support operational improvements.
- Delivered insights and updates to stakeholders to support informed decision-making and risk mitigation.
- Contributed to employee engagement through committee participation and DEI initiatives.
- Promoted to Associate Project Manager in Oct. 2020.
Senior Provider Data Analyst
UnitedHealthcare (PCQA)
07.2016 - 10.2018
- Conducting in-depth analysis of claims and internal activities to identify and thoroughly understand the drivers of the large claim rework projects.
- Scheduling multiple meetings with stakeholders to discuss project details such as obtaining description of issue, clear remediation plans, interest determination, settlement viability, and timeline.
- Preparing detailed summaries for presentation to leaders at the Claim Project Review Board.
- Making recommendations to enhance business processes and updating the Claim Project Triage database.
Sr Contract Research Analyst/Provider Reimbursement
UnitedHealthcare (PCRL)
02.2013 - 07.2016
- Conducting in-depth research and reviewing claims, systems, and policies to determine accurate provider setup.
- Facilitating contract corrections and documenting findings/outcomes to internal business partners within a specified time frame.
- Analyzing and investigating reimbursement disputes for all provider types (Hospital, physician, ancillary, DME, Hospice, ASC).
- Reaching out to health plan to obtain hard copy contracts, assist in review of setup, fee schedule updates, and conducted provider education.
- Assigned to conduct root cause analysis for high dollar interest issues for our defect area (Contract load/Maintenance).
Network Medical Cost Management Analyst
Optum Insight
01.2008 - 02.2013
- Performed detailed claims review analyses to assess audit potential and identify pre-audit findings, contributing to risk mitigation and compliance efforts.
- Assisted in identifying over 1M in claim overpayments.
- Collaborated with external vendors to streamline the audit process and resolve access-related challenges, ensuring smooth project execution.
- Selected by leadership to serve as Co-Chair on the site’s inaugural Optum Employee Engagement Committee, demonstrating strong leadership and commitment to organizational culture.
- Spearheaded community service initiatives, organized team-building events, and facilitated focus group sessions to gather and act on employee survey feedback.
Medicare Coordinator
Ovations/United Healthcare
11.2006 - 01.2008
- Served as a liaison between health plans, members, and providers, advocating for member needs and resolving complex issues related to billing, coverage, appeals, and provider network access.
- Managed escalated concerns with professionalism and efficiency, ensuring timely resolution and member satisfaction.
- Educated members and providers on UnitedHealthcare (UHC) plans, including Part D coverage, and ensured compliance with Medicare and Medicaid guidelines.
Provider Service Representative
Ovations/United Healthcare
11.2005 - 11.2006
- Handled inquiries and service requests from physicians, hospitals, and ancillary providers related to provider complaints, claims processing, appeals, eligibility and benefit issues.
- Interpreted UnitedHealthcare policies and conducted detailed research on claims to ensure accurate resolution.
- Demonstrated strong performance and subject matter expertise, resulting in promotion within one year to the Medicare Research Team as a Medicare Coordinator.
Education
Bachelor of Science - Business of Science in Administration
University of Phoenix
Miramar, FL07-2013
Skills
- Medical terminology expertise
- Proficient in Microsoft Word, Excel, and PowerPoint
- Proficient in vendor relations
- Skilled in Application Programming Interface
- Bilingual proficiency in Spanish and English
- Effective presentation abilities
- Project oversight
- Problem-solving expertise
- Employee engagement expert
- Provider collaboration initiatives
- Effective public speaking
- Proven digital sales expertise
Accomplishments
2024 UnitedHealthcare - Service Hero Winner
2023 UnitedHealthcare - Service Hero Finalist
2023 Emerging Leader
2021 UnitedHealthcare - Service Hero Finalist
Certification
2018 - Project Managment Training
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
Senior Digital API Consultant/Business Consultant
UnitedHealthcare (PSO)
11.2021 - Current
Associate Project Manager/Sr. Business Process Analyst
UnitedHealthcare (PDT)
10.2018 - 11.2021
Senior Provider Data Analyst
UnitedHealthcare (PCQA)
07.2016 - 10.2018
Sr Contract Research Analyst/Provider Reimbursement
UnitedHealthcare (PCRL)
02.2013 - 07.2016
Network Medical Cost Management Analyst
Optum Insight
01.2008 - 02.2013
Medicare Coordinator
Ovations/United Healthcare
11.2006 - 01.2008
Provider Service Representative
Ovations/United Healthcare
11.2005 - 11.2006
Bachelor of Science - Business of Science in Administration
University of Phoenix
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