Health Promotion Quality Assurance
Resume:
JOSE VICHOT
Quality Management Health Promotion Consultant
786-***-**** ad774g@r.postjobfree.com http://linkedin.com/in/jose-vichot Miami, Florida
EXPERIENCE
Health Promotion Consultant
Elevance Health
01/2022 - Present Miami
Analyze and interpret HEDIS data to identify gaps in care and opportunities for improvement, focusing on enhancing member and provider engagement.
Develop and execute strategic health promotion initiatives aimed at improving preventive care, chronic disease management, and overall member health outcomes.
Promote health benefits to members, ensuring they are informed and can utilize available resources to improve their health. Work with providers to optimize care delivery practices, ensuring adherence to HEDIS guidelines and standards while fostering stronger engagement.
Monitor and report on program outcomes, using data-driven insights to refine and enhance health promotion strategies.
Provide education and support to healthcare teams on best practices for HEDIS measure performance and effective member communication. Stay informed on industry trends and regulatory changes impacting HEDIS, health benefits, and quality improvement efforts. Complaints To Medicare Team Lead
Elevance Health
05/2020 - 01/2022 Miami, Florida
Led and mentored a team of 20 professionals, fostering a culture of continuous improvement and high performance.
Provided ongoing coaching and feedback on quality audit results, ensuring consistent adherence to quality standards.
Developed and implemented KPIs to monitor team performance, using data-driven insights to drive improvements in complaint resolution. Created and maintained SOPs for the Complaint to Medicare process, ensuring compliance and operational efficiency.
Collaborated cross-functionally with departments such as Compliance, Quality Assurance, and Customer Service to streamline processes and enhance complaint management.
Regularly reported to senior management on team performance, identifying trends, areas for improvement, and success stories. Led process improvement initiatives that enhanced efficiency, quality, and customer satisfaction in Medicare complaint handling. Performance Quality Auditor
Anthem
08/2014 - 04/2020 Miami
Conducted comprehensive audits of Medicare and Medicaid complaint resolutions, ensuring compliance with CMS guidelines and internal quality standards.
Provided detailed feedback and actionable insights to complaint management teams to improve resolution accuracy, timeliness, and overall service quality.
Played a key role in CMS audit preparation and participation, ensuring that all documentation and processes were audit-ready and aligned with regulatory expectations.
Developed and implemented quality assurance processes to monitor and improve the handling of Medicare and Medicaid complaints. Collaborated with cross-functional teams, including Compliance, Quality Assurance, and Operations, to address audit findings and implement corrective actions.
Tracked and reported on audit outcomes, identifying trends and areas for ongoing process improvement.
Ensured that all audit activities were documented thoroughly and in accordance with regulatory and organizational requirements. SUMMARY
Professional Healthcare Consultant professional
with over 10 years experience in program
management and data analysis. Proven track
record leading operational initiatives enterprise- wide to achieve Customer Success and enhance
Customer Experience. Expertise in initiating,
planning, and monitoring program implementations
for timeliness and compliance. Proficient in
analyzing performance indicators and driving
operational excellence. Excellent communicator and leader, adept at energizing teams to exceed
standards and streamline workflows. Effective in
engaging stakeholders, ensuring regulatory
compliance, and surpassing expectations.
LANGUAGES
Spanish
Native
SKILLS
Provider data Microsoft Office
SalesForce
SPS (Strategic Provider System)
Tableau PowerBI QNXT/Facets
SOP & KPI Creation
People Management
Client Management
Customer Experience ServiceNow
Healthcare Consulting
Portfolio Management
Claims Processing Managed Care
Data Analysis Compliance Oversight
EDUCATION
Associates Degree (Pre-Law)
Miami Dade College
2008 - 2010
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