RUIXUE XU
Wellesley,MA
Summary
Healthcare professional with extensive clinical and administrative experience across payer, provider, and policy domains. Bilingual in English and Mandarin, effective in managing high-volume case loads while optimizing Medicaid enrollment processes through cross-functional collaboration and data analysis.
Overview
1
1
Certification
6
6
years of professional experience
Work History
Patient Advocate Specialist-East Coast Region
Patient Funding Alternatives
Boston, Massachusetts
04.2026 - Current
- Manage Medicaid Health Insurance Premium Payment (HIPP) enrollment across leading academic health systems: Mass General Brigham, New York-Presbyterian, Northwell Health, and Memorial Sloan Kettering Cancer Center.
- Navigated complex Medicaid eligibility and payer requirements to optimize coverage solutions and minimize financial barriers to care.
- Partner cross-functionally with hospital financial counselors, clinical teams, and state Medicaid agencies to streamline enrollment workflows and expedite case resolution.
- Analyze patient financial and insurance data to identify optimal funding pathways while ensuring regulatory compliance and program integrity.
- Balanced high-volume case management of 200 cases per week while maintaining quality standards (95-100/100) and enhancing patient experience to meet performance and enrollment objectives.
- Built patient trust through effective communication and education, resolving issues to enhance engagement throughout enrollment process.
Extended Administrative Resident
UPMC Health Plan
Pittsburgh, USA
06.2023 - 05.2024
- Advanced payer strategy by delivering data-driven recommendations across Medicare Stars, SNP Operations, and Population Health, shaping initiatives that impacted 100K+ covered lives.
- Led competitor market analysis across 10+ regional health plans; findings informed leadership on positioning Medicare/SNP offerings and shaped 2024-2025 benefit design.
- Built and delivered training resources for 50+ new hires annually, streamlining onboarding process and enhancing integration into the team.
- Developed and deployed Power BI dashboards integrating clinical and population health data, cutting reporting time from days to hours and allowing executives to quickly identify performance gaps.
Medicare Appeal Representative
Acentra (Formal Keystone Peer Review Organization)
Harrisburg, USA
04.2022 - 07.2022
- Managed 150+ referrals weekly and coordinated with CMS/state-level agencies to resolve coverage disputes, enhancing beneficiary-provider relations.
- Strengthened beneficiary advocacy by streamlining Medicare appeal communications, supporting hundreds of cases monthly with improved clarity and turnaround time.
- Conducted workflow quality reviews and implemented process refinements, increasing case processing efficiency by 15%.
Respiratory Therapist
UPMC Shadyside
Pittsburgh, USA
06.2020 - 02.2021
- Delivered ICU and surgical respiratory care to 200+ patients, applying evidence-based interventions that improved outcomes and reduced complications.
- Collaborated with physicians, nurses, and multidisciplinary teams to enhance bedside care and improve hospital operations.
- Educated patients and families on long-term respiratory health, fostering preventive care practices that contributed to reduced readmission risk.
- Gained in-depth understanding of healthcare systems and patient needs, informing strategy and consulting projects with unique clinical insights.
Education
MPH - Health Policy and Management, Certificate in Health Systems Leadership Management
University of Pittsburgh
Pittsburgh, PA04-2024
BA - Healthcare Management & Supervision
University of Pittsburgh At Johnstown
Johnstown, PA04-2020
Associate Degree - Respiratory Care
University of Pittsburgh at Johnstown
04-2020
Skills
- Medicaid eligibility
- Enrollment optimization
- Insurance navigation
- Regulatory compliance
- Patient advocacy
- Case management
- Patient outcome tracking
- Data analysis
- Workflow improvement
- Healthcare trends
- Caseload management
- Care improvement
- Patient advising
- Interdepartmental cooperation
- Proficient in [software]
- Effective communication
- Trust development
- Communication skills
- Regulatory analysis
Affiliations
- Health Policy and Management Association in Pitt Public Health
- American College of Healthcare Executives
- Pitt Student Government Association
Certification
- Certified Respiratory Therapist (NBRC)
- HarvardX Certificates (Culture of Health, FDA Drug Regulation/Access)
- Healthcare System Leadership Management Certificate (Pitt, 2024)
Signature Highlights
- Improved patient outcomes and safety through 1 year of ICU and inpatient respiratory care, bringing unique clinical insight now leveraged in strategy and consulting projects.
- Advanced payer strategy and efficiency during UPMC Health Plan residency, driving process improvements and data-driven recommendations across Medicare, SNP, and population health.
- Demonstrated consulting potential by leading 3 national/local case competition teams, including a 2nd place finish at Pitt's Global Health Competition.
- Bilingual in Mandarin and English, bridging cultures and stakeholders to strengthen collaboration in diverse healthcare environments.
Timeline
Patient Advocate Specialist-East Coast Region
Patient Funding Alternatives
04.2026 - Current
Extended Administrative Resident
UPMC Health Plan
06.2023 - 05.2024
Medicare Appeal Representative
Acentra (Formal Keystone Peer Review Organization)
04.2022 - 07.2022
Respiratory Therapist
UPMC Shadyside
06.2020 - 02.2021
MPH - Health Policy and Management, Certificate in Health Systems Leadership Management
University of Pittsburgh
BA - Healthcare Management & Supervision
University of Pittsburgh At Johnstown
Associate Degree - Respiratory Care
University of Pittsburgh at Johnstown