Summary
Overview
Work History
Education
Skills
Timeline
Generic

SAMANTHA ARAGON

Torrance,CA

Summary

Forward-thinking Healthcare Consultant possessing over 13 years of health care experience with demonstrated success in improving quality performance and increasing operational efficiency within fast-paced roles. Detail-oriented and dedicated to boosting all areas of operations and business administration in healthcare industry. Commended for building trusting relationships with stakeholders and customers.

Overview

14
14
years of professional experience

Work History

Market Consultation and Partnership Lead

Humana
03.2023 - Current
  • Established strong and trusting working relationships with various leadership level roles across 4 West Division Regions and other internal business partners within Risk
    Adjustment, Quality/Stars, and Interoperability teams by using consultative recommendation processes critical to success.
  • As a primary strategic liaison between our corporate partners and the assigned divisional market leaders, I am responsible for supporting and driving changes by recommending appropriate levers to achieve market KPIs and OKRs and drive optimal outcomes.
  • Consistently collaborate with Interoperability and Prospective Programs teams to triage solutions with the markets on education, goal setting recommendations, and internal process reviews.
  • While populating Stars slide templates for Regional Market Reviews, I was able to contribute to the creation of a better streamlined view which will assist the markets in portraying their state of the Region reviews to executive leadership.
  • Deployed RA and Stars homestretch market support activities in Q4 of 2023, in which I supported deployment of the high acuity outreach initiative driving completion of 550+ visits YTD (IMR, PSW, Central, S. Central). Helped kick off the Stars homestretch workgroups to improve shared contract performance and shared facilitation/ownership of the HQRI Market Collaboration sessions by engaging key stars SMEs to deploy market education.
  • Earned a Silver Star Award for taking on a stretch assignment assisting the National Strategic Partners with strategy and consultative review of Stars Performance
  • Joined the 2024 RAISE (Risk Adjustment, Interoperability, and Stars Experience) planning committee where I was able to expand my knowledge and broaden my interpersonal skills by forming new relationships with corporate business owners.
  • Gained a mentor in the Interoperability space, Kristen Bucko, who I am fortunate enough to learn from and grow my knowledge of Humana's Interop strategies and products.
  • Provide ongoing support to markets during periods of transition or organizational restructuring, helping minimize disruptions to daily operations.

Sr. Stars Improvement Professional

Humana
03.2019 - 03.2023
  • Establish valuable relationships with IPA executive leadership and leverage these relationships to influence performance improvement for the Stars Rating Program
  • Partner with Provider Engagement, Marketing, HSO, and Risk Adjustment teams to support 17 groups responsible for over 40,000 members across the southern region of California as Stars point of contact
  • Facilitate strategy meetings to discuss initiatives, barriers, and action plans including Joint Work Groups, Joint Operation Committees, and Stars Performance Meetings
  • Present Patient Experience trainings to IPAs and medical groups while engaging staff to implement changes in their workflows to improve CAHPS/HOS ratings
  • Travel to various PCP offices to educate providers and staff on key Stars metrics and present open gaps in care; discuss any barriers and best practices, discuss connectivity recommendations through supplemental data files and EMR connectivity.
  • Completed profiles for 19 provider groups under the LA/Kern Market - these profiles assist in creating action plans and strategies when meeting with provider groups for Stars Performance improvement
  • Presented goals, action plans, and strategies for the LA/Kern market groups to the Desert Pacific senior leadership team during Mini Market Reviews.

Sr. Provider Relations Specialist

Torrance Memorial Health System
03.2015 - 03.2019
  • Work closely with MSO on work group projects aimed at streamlining processes and complying with health plan standards
  • Led successful implementation of workflows during a three-month transition period of MSO companies
  • Support, develop, and maintain service relationships with 100 Southbay physicians, providers and administrators within Torrance Memorial Health System network and its partners
  • Respond to inquiries from stakeholders about policies, rate changes, referrals, eligibility, and credentialing
  • Provide guidance, expertise, and delegation to coordinators and representatives with less experience
  • Assist the contracts manager and credentialing coordinator with onboarding new physicians
  • Serve as a resource for physicians by providing information about network procedures or contracts
  • Monitor and consult on provider performance including patient experience, quality metrics, ACO shared savings programs, Connectivity with the HIE (Health Information Exchange) and HCC Risk Adjustment practices
  • Provide extensive research and root-cause analysis to resolve billing and claims issues to ensure payments are made according to managed care contracts
  • Assist with quality-of-care grievances, compliance audits, utilization management referrals processes, finance department capitation and incentive calculations, and provider data updates and rosters
  • Organize and participate in physician and office manager meetings to provide updates to stakeholders.

Population Health Specialist

Torrance Memorial Health System
03.2015 - 10.2017
  • Led the successful improvement of medical group's overall Medicare STAR rating to above a 4 STAR and improved quality metrics through increased Annual Wellness Visit completion
  • Contributed extensively to progression of the Health Information Exchange (HIE) project by meeting with Cerner project managers and gaining buy-in while recruiting participation from local physicians on various EMR systems. Participated in back-end process of removing duplicative member profiles and connecting to main hospital system, PowerChart.
  • Streamlined existing processes within the ACO Medicare Shared Savings Program, focusing heavily on maintaining regulatory compliance, ensuring quality control, and completing annual PQRS/GPRO audits.
  • Completed yearly chart abstractions from various EMR systems such as NextGen, Athena, ECW, for HEDIS gap closures and HCC submissions.
  • Compiled and analyzed pertinent data to prepare reports for presentations to upper management and providers
  • Utilized excellent interpersonal skills to serve as a liaison for providers and health system partners
  • Educated providers on HEDIS/IHA specifications and billing processes through the MSO - collaborated with them to ensure that procedures and processes promoted operational efficiency and patient satisfaction
  • Partnered with risk adjustment team to conduct Chart Reviews and educate physicians on the HCC/RAF program
  • Coordinated a stock offering for physician shareholders; raised over $2.7M.

Clinical Care Extender Intern

COPE Health Solutions, St. Mary Medical Center
01.2015 - 01.2016
  • Basic patient care duties including bathing, changing, transporting, and feeding patients; answering call lights
  • Provided administrative support for registered nurses and physicians.

Physician Liaison

West Gastroenterology Medical Group
01.2012 - 01.2013
  • Maintained open lines of communication between nurses, patients, and physicians
  • Coordinated the schedules of 5 resident physicians, including consults and surgeries
  • Logged incoming consults from various hospitals within the Los Angeles area and utilized strong organizational skills to ensure accuracy of patient scheduling for office visits using NextGen EMR.

Same-Day Services Coordinator, Pharmacy Technician

AIDS Healthcare Foundation
01.2010 - 01.2012
  • Fulfilled critical coordinator role within an HIV/AIDS specialty care pharmacy; successfully processed and filled up to 300 prescriptions daily
  • Provided top notch customer support; resolved inquiries, collected payments, and scheduled deliveries of patient orders.

Education

Master of Business Administration, Health Management -

University of Phoenix
Gardena, CA

Bachelor of Science - Health Administration

University of Phoenix
Gardena, CA

LEAN Foundations Certification -

Torrance Memorial Medical Center
Torrance, CA

California Pharmacy Technician License -

Everest College
City of Industry, CA

Skills

  • Knowledge and experience in implementing LEAN practices into company-wide workflows
  • Subject matter expert in Stars (HEDIS, Patient Safety, and Patient Experience) performance and best practices
  • Proficient in PowerBI reporting, Microsoft applications, and Compass Analytics
  • Experience in contracting, health plan audits, bonus and reimbursement methodologies, risk adjustment, and project management
  • Experience with various EMR systems and Health Information Exchange connections
  • Dynamic interpersonal skills; instrumental to interfacing with executive leadership, physicians, nurses, and patients
  • Ability to manage multiple projects and tasks while meeting deadlines
  • Healthcare analytics and performance monitoring background allowing for process and quality improvement
  • Strong healthcare consulting and networking skills instrumental to managing professional relationships

Timeline

Market Consultation and Partnership Lead

Humana
03.2023 - Current

Sr. Stars Improvement Professional

Humana
03.2019 - 03.2023

Sr. Provider Relations Specialist

Torrance Memorial Health System
03.2015 - 03.2019

Population Health Specialist

Torrance Memorial Health System
03.2015 - 10.2017

Clinical Care Extender Intern

COPE Health Solutions, St. Mary Medical Center
01.2015 - 01.2016

Physician Liaison

West Gastroenterology Medical Group
01.2012 - 01.2013

Same-Day Services Coordinator, Pharmacy Technician

AIDS Healthcare Foundation
01.2010 - 01.2012

Master of Business Administration, Health Management -

University of Phoenix

Bachelor of Science - Health Administration

University of Phoenix

LEAN Foundations Certification -

Torrance Memorial Medical Center

California Pharmacy Technician License -

Everest College

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SAMANTHA ARAGON