Sebastián De Jesús Muñoz Santana
Store Manager
Temple,TX
Summary
Subject Matter Expert with over 4 years of experience in the Healthcare & Medicare field, in particular Costumer Service, HIPAA Compliance and HEDIS Measures. Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. Driven individual who strives at excellence and professionalism and strives to be an important company asset.
Overview
10
10
years of professional experience
6
6
years of post-secondary education
Work History
Accounting Assistant II
Baylor Scott & White Health Plan
07.2023 - Current
- Used accounting software to prepare weekly and monthly financial reports.
- Maintained clean and organized files by keeping accounts payable records up-to-date.
- Applied proper codes to invoices, files, and receipts to keep records organized and easily searchable.
- Maintained accurate and complete documentation to facilitate accounting and filing functions.
- Gathered, evaluated and summarized account data in detailed financial reports.
- Managed and responded to correspondence and inquiries from customers and vendors.
- Handled day-to-day accounting processes to drive financial accuracy.
- Supported management by processing invoices and documents with consistent on-time delivery.
- Input financial data and produced reports using HealthEdge and Amisys.
- Assisted in the creation and resolution of tickets and issues to assure accurate delivery of payment to our customers and vendors.
- Assist in the creation and maintenance to Training Manual and Processees directly associated with Claims Payable.
- Supported accurate accrual of sample requests for CMS, STAT & GAAP audits.
- Executed payment reprocessing as directed by providers, beneficiaries and upper management.
- Financial Activity research of payments made to providers and beneficiaries to corroborate reconciliation of payments.
- Conducted research on Pay to Addresses to ensure prompt delivery of returned correspondence.
- Contributed to drafting Standards of Procedures for Claims Payable.
Accounting Assistant II
CareNational, Baylor Scott & White Health Plan
02.2023 - 07.2023
- Used accounting software to prepare weekly and monthly financial reports.
- Maintained clean and organized files by keeping accounts payable records up-to-date.
- Applied proper codes to invoices, files, and receipts to keep records organized and easily searchable.
- Maintained accurate and complete documentation to facilitate accounting and filing functions.
- Gathered, evaluated and summarized account data in detailed financial reports.
- Managed and responded to correspondence and inquiries from customers and vendors.
- Handled day-to-day accounting processes to drive financial accuracy.
- Supported management by processing invoices and documents with consistent on-time delivery.
- Input financial data and produced reports using HealthEdge and Amisys.
- Assisted in the creation and resolution of tickets and issues to assure accurate delivery of payment to our customers and vendors.
Manager
Axcess Financial, Check N' Go
09.2021 - 12.2022
- Monitored expenditures to mitigate risk of overages.
- Maximized performance by monitoring daily activities and mentoring team members.
- Provide training to new employees.
- Handle and count currency, cash, and coins to include managing cash drawer, counting cash deposits, moving cash from secure safe to cash drawer and other cash handling requirements.
- Responsible for bank deposits or bank pick-ups.
- Balance individual batch receipts with store sales reports at end of day and assist with resolving over/shorts as needed.
- Loan processing and perform customer verification process to validate information presented.
- Accurately process all transactions per company policy, including but not limited to loans, check cashing and, Net Spend.
- Accurately process loans and transactions per company policy.
- Answer inbound calls and assist with customer inquiries, applications, requests and outgoing customer courtesy and collection calls in accordance with federal regulations and store operating procedures managing in average 80 - 120 calls daily.
- Engaging in active listening with callers, confirming or clarifying information and diffusing customer complaints.
- Maintain business relationships with local businesses to expand marketing and exposure.
- Maintain store presentable and organized.
<p>Drug, Entertainment and General Merchandise Partner</p>
HEB, Drug-Tech-General Merchandise 4
10.2018 - 08.2021
- Provide assistance in allocation of product to their respective aisles, shelves, bins and shippers.
- Experience in art and design of merchandising singular or various products to meet needs and expectations of our target market.
- Provide personalized service to our customers and colleagues in order to satisfy their immediate needs.
- Certified in use of forklifts and power jacks.
- Daily auditing of merchandise to assure product availability.
- Experience in use of SRS System, which assists user in regard to product allocation and inventory.
- Named Signature Partner in 2018, title bestowed to partners who provide exceptional service and make its respective store one to visit.
<p></p><p>Subject Matter Expert</p>
Molina Healthcare of Puerto Rico, HEDIS Appointment Team
11.2015 - 09.2018
- Extensive utilization and experience with QNXT, Salesforce, Acqueon List & Campaign Management (LCM) and CISCO Unified Intelligence Center.
- Assist in creation and implementation of policies, procedures and training material, to meet needs and standards of HEDIS Appointment Team.
- Provide training to a group of 19 individuals of the HEDIS Appointment Team during each revision of the systems here disclosed.
- Provide Assistance to both Supervisor and Team Lead in overview and production of daily, weekly and monthly departmental performance reports.
- Assists in production and management of HEDIS/EPSDT Measures through use of an automatic ‘dialer’ campaigns as well as production of manual campaigns of the same nature and monitoring of their progress.
- Assist on monthly auditing of Salesforce documentation of HEDIS agents.
- Extensive knowledge of HIPAA Compliance implementation as well as HEDIS/EPSDT Measures.
- Experience in translating text, scripts and presentations from English to Spanish and Vice-Versa across all the Departments Molina Healthcare of Puerto Rico.
<p></p><p>Credentialing Clerk (Temporary)</p>
Molina Healthcare of Puerto Rico, Credentialing Department
12.2017 - 04.2018
- Assisted the Credentialing Department in tandem with Agilerta Credentialing Resources in process of analysis and submission of credentialing applications, licenses and credentials.
- Experience Utilizing CACTUS Provider Management Platform and its interface.
- Knowledge of Credentialing Policies and Requisites of ASES and Molina Healthcare of Puerto Rico.
- Experience utilizing Laserfiche: Enterprise Content Management Platform for record keeping and organization of provider’s credentialing applications, licenses and credentials.
- Kept record of received correspondence and relayed information to the Credentialing Team.
- Assisted in credentialing and re-credentialing of 157 Providers and Facilities during tenure at the Credentialing Department.
Education
BBA - Marketing
Universidad Del Este, IEN Business School
Carolina, PR 08.2007 - 05.2013
Skills
Advanced knowledge of MS Excel (pivot tables, VLOOK up, data visualization) MS Powerpoint (creating comprehensive training and instructional presentations) and MS Word
Fluent in English and Spanish, both in written and spoken
Problem Identifying and Problem Solving
Highly adaptable to shifting working conditions
Timeline
Accounting Assistant II
Baylor Scott & White Health Plan
07.2023 - Current
Accounting Assistant II
CareNational, Baylor Scott & White Health Plan
02.2023 - 07.2023
Manager
Axcess Financial, Check N' Go
09.2021 - 12.2022
<p>Drug, Entertainment and General Merchandise Partner</p>
HEB, Drug-Tech-General Merchandise 4
10.2018 - 08.2021
<p></p><p>Credentialing Clerk (Temporary)</p>
Molina Healthcare of Puerto Rico, Credentialing Department
12.2017 - 04.2018
<p></p><p>Subject Matter Expert</p>
Molina Healthcare of Puerto Rico, HEDIS Appointment Team
11.2015 - 09.2018
BBA - Marketing
Universidad Del Este, IEN Business School
08.2007 - 05.2013
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