Summary
Overview
Work History
Education
Skills
Timeline
Generic
Salvador Horta

Salvador Horta

Naples,Florida

Summary

Experienced professional with ten years in insurance and health care leadership roles. Proficient in account oversight, data-driven decision making, and team management. Focused on utilizing accumulated skills to contribute to the success of a progressive company.

Overview

6
6
years of professional experience

Work History

Human Resource/Compliance Manager

Healthcare Talent, Inc.
08.2020 - 03.2021
  • Maintained confidential personnel files, and personnel actions, and insured compliance with all applicable laws and regulations.
  • Administered various Human Resources programs and process, including employee on boarding, off boarding, and performance management.
  • Supported Human Resources projects.
  • Stayed up-to-date on industry, trends and best practices in Human Resources.
  • Manage compliance team, staff and organized maintenance regulatory files.
  • Managed and directed other related duties as assigned face-to-face interviews on Skype or zoom interviews.

Medicare Claims Examiner/ Provider Relations & Contracts

Golden State Medicare Health Plan / Connected Care Resources
10.2019 - 03.2020
  • Worked closely in training a staff of seven people in the process of Medicare claims
  • Instructed staff on how to reach out to providers to supply further research information
  • Worked close with IPAs and physicians on process and processed the concerns of providers in terms of payment health staff
  • Reviewed many of the denied claims giving an educated answer as to why claims were denied
  • Assisted with complying maintenance and related documentation

Compliance and Regulatory Auditor

United Health Care / Monarch
07.2017 - 01.2019
  • Reviewed and resolved provider inquiries and disputes for medical claims processing systems
  • Oversaw claims examiners for accuracy and business policies
  • Extracted and adjudicated disputes for contested claims
  • Identified claims that have been processed with problems and found amiable solutions

Denials in Appeals Resolution Coordinator

Molina Health Care
05.2015 - 07.2017
  • Assessed and completed appropriate documentation for tracking trending data
  • Analyzed and resolved verbal/written claims, grievances, and appeals of providers and members
  • Conducted pertinent research to evaluate, respond, and close incoming provider disputes
  • Procured supplies and resources for consultancy services to prevent provider fraud and abuse
  • Aided in conflict resolution with difficult situations concerning insurance disputes

Education

Bachelor of Science - Business Management

University of Phoenix
LA Mirada, CA
11.2010

High School Diploma - General Studies

South Gate High School
South Gate, CA
06.1989

Skills

  • Training oversight and development
  • Leadership abilities
  • Analytical problem-solving
  • Effective communication skills
  • Attention to detail
  • Healthcare policy knowledge
  • Technological adaptability
  • Data management expertise
  • Time management strategies
  • Organizational skills

Timeline

Human Resource/Compliance Manager

Healthcare Talent, Inc.
08.2020 - 03.2021

Medicare Claims Examiner/ Provider Relations & Contracts

Golden State Medicare Health Plan / Connected Care Resources
10.2019 - 03.2020

Compliance and Regulatory Auditor

United Health Care / Monarch
07.2017 - 01.2019

Denials in Appeals Resolution Coordinator

Molina Health Care
05.2015 - 07.2017

Bachelor of Science - Business Management

University of Phoenix

High School Diploma - General Studies

South Gate High School

Similar Profiles

CREATE PROFILE