Tiffanny Zapata
Montclair,CA
Summary
Healthcare professional with over 10 years of experience in quality and performance improvement activities within the health plan and ambulatory care setting. Highly driven and passionate to engage in work that will foster relationship building with stakeholders, achieving performance metrics, and make an impact in the community.
Overview
8
8
years of professional experience
Work History
Quality Improvement Facilitator II
Inland Empire Health Plan
02.2022 - Current
- Leads the facilitation in the development and implementation, including creating project plans, of quality improvement initiatives related to strategies that will support hospitals in reaching their Pay for Performance (P4P) goals
- Oversees, analyzes, monitors, and report out on all phases (from planning to execution) of quality improvement projects
- Collaborates closely with internal staff and external hospital partners (including leaders and executives) to identify gaps in knowledge/processes and ensure timely project completion to achieve shared organization goals
- Identifies opportunities for improvement within the department workflows, provides recommendations utilizing lean thinking, then develops, leads, create tools/standard works, and implement projects that will result in increased performance, productivity, and efficiency
- Provide consultation to team members on hosting provider education, project management and utilizing tools, such as WorkFront, and with hospital partners relating to organizational strategies
Quality Improvement Specialist
Cedars Sinai
02.2021 - 02.2022
- Monitored and analyzed health plan and internal care gap report, identified opportunities to close care gaps and improved accurate data capture; worked with operations to find solutions and disseminate
- Validated health plans’ performance score cards and submitted accurate evidence to close the patient care gaps by deadline ensuring to meet targets by the end of the measurement year
- Managed and or participated in implementing pilot projects assigned related to improving quality scores and utilize lean methodologies as needed
- Conducted and participated in outreach initiatives, such as collaborated with internal and external departments to gather resource needs for pilot projects, created scripts, sent bulk orders/letters, and outbound calls to patients
- Prepared required quality program audit documents, created internal department’s standard work documents
Quality Improvement Specialist
Providence Heritage Healthcare
06.2019 - 02.2021
- Managed and built relationships with 17 sites as part of the medical group consisting of primary care and specialty offices, and multiple individual provider offices as part of the affiliates group ensuring that all clinic staffs are trained and educated on HEDIS measures and expectations to meet year end goal
- Consulted with provider offices on best practices/workflow recommendations to close care gaps and improve overall quality scores
- Worked closely with the Medical Director and Executives, presented my findings on barriers/opportunities for each quality metric, presented provider performance trends, and strategized to ensure that the group achieved target goals for incentive payouts
- Communicated the vision to change care practices through quality improvement by presenting at clinics and physician meetings, creating educational materials and providing trainings on topics, such as best practices, clinical documentation, and HEDIS measures to management, clinic staffs, and physicians
- Piloted and managed quality improvement projects, set goals, oversee each phase of the project, such as training, tracking, analyzing, evaluation of effectiveness, and reporting outcomes to improve quality of care
- Created scripts and managed outreach initiatives, such as letters, phone calls, voicemail drops, and text messages sent to patients who are due for preventative screenings
- Collected medical records, reviewed, and audited clinical notes to ensure accuracy of documentation for reporting per regulatory and health plan guidelines.
Sales Quality Control Specialist
L.A Care Health Plan
05.2017 - 05.2019
- Monitored and audited sales calls, documentations, and field marketing presentations to ensure quality of performance and compliance of CMS, Medi-Cal, and other regulatory requirements
- Evaluated, analyzed, and wrote weekly and/or monthly reports on performance of sales representatives to maximize sales enrollments, as well as made recommendations that are used for performance assessments
- Identified ongoing training needs for representatives, collaborated with internal departments for product/benefits knowledge as well as processes to increase sales, created training surveys, materials/presentations, and presented these to the team when asked by management
- Was responsible for on-boarding training of new hires and acted as an ongoing support for the representatives
- Collaborated with management to identify trends and deficiencies and recommended solutions, designed, created, and implemented tools to continuously improve quality and processes
- Proposed recommendations and assisted in writing policies and procedures, reviewed sales allegations and reported outcomes, participated and attended field marketing events, worked on special projects and ensured timely completion.
Quality Assurance Data Coordinator
Planned Parenthood Los Angeles
03.2016 - 05.2017
- Analyzed and synthesized data for marketing, patient services, and call center department to inform management of issues and or trends, improve efficiency, monitor progress, and maximize patient satisfaction
- Projected future data and created reporting in formats such as graphs, dashboards, PowerPoints, or summaries
- Ensured integrity of data, developed data standards, procedures and training for call center staff members
- Trained and mentored new hires, provided assistance and peer coaching, monitored call center agents regularly through the system and provided feedback to the Call Center Manager
- Designed and implemented spreadsheets to track patient demand, call center performance, and reporting
Education
Bachelor of Science in Health Science, Minor in Business Administration -
California State University, Fullerton
Master of Science in Health Care Administration -
California State University, Long Beach
Skills
- Project Management
- Strategic Planning
- Task Delegation
- Feedback Delivery
- Relationship Building
- Meeting facilitation
- Continuous Improvement
Timeline
Quality Improvement Facilitator II
Inland Empire Health Plan
02.2022 - Current
Quality Improvement Specialist
Cedars Sinai
02.2021 - 02.2022
Quality Improvement Specialist
Providence Heritage Healthcare
06.2019 - 02.2021
Sales Quality Control Specialist
L.A Care Health Plan
05.2017 - 05.2019
Quality Assurance Data Coordinator
Planned Parenthood Los Angeles
03.2016 - 05.2017
Bachelor of Science in Health Science, Minor in Business Administration -
California State University, Fullerton
Master of Science in Health Care Administration -
California State University, Long Beach
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