Sergio Acosta Email & Phone Number

Phoenix Az

• Manage daily activities of the Health Risk Assessment Department, responding to complex inquiries regarding benefits, eligibility, and other related information, providing prompt solutions with frequent interruptions.• Run Aceyus, SSRS and MHK reports, analyzing large amounts of data to ensure productivity demands are met compliantly within the allocated time frame. • Conduct quality meetings with staff and coached on error trends and audit findings to ensure productivity, compliance, and quality metrics are met, in accordance with CMS regulations and guidance. • Collaborate with management assisting with changes in policies and procedures, developing processes to achieve departmental goals. • Lead the STARS project, assisting the department in increasing the STAR Ratings in certain markets from 3 to 4 STARS.

Phoenix Az

• Worked productively as a patient advocate, aligning patients to programs and services to help break down barriers that would interfere with completion of care plans, keeping patient information private, complying with HIPAA guidelines.• Met productivity standards by reaching daily goals, telephonically assisting SNP and Medicare Advantage Plan members to complete Health Risk Assessments, aligning members to programs and services, while adhering to Internal and CMS compliance guidelines. • Audited HRA team phone calls, advising Management of Observations and Best Practice opportunities, training and coaching staff to improve performance.

Phoenix, Arizona

• Primary point of Contact for High-Risk Patients withing the Chronic Special Needs Medicare Advantage Plan, providing continuous follow up to improve quality of services and prevent hospital readmissions, reducing costs and increasing revenue. • Effectively coordinated collaboration between Population Health Management, Network Operations and Independent Providers, to ensure we met our Model of Care Goals by identifying and closing gaps in care for our Most Vulnerable SNP and High-Risk Medicare Advantage patients. • Subject Matter Expert in Care Coordination and Chronic Health Improvement Programs, successfully trained and coached clinical and non-clinical staff members.

Phoenix, Arizona

• Collaborated with Population Health Management staff, building professional relationships with Patients, Providers, Nurses, Social Workers, Case Managers, Hospital, SNF, Rehab and Hospice Personnel which improved and facilitated the coordination of patient care.• Primary point of contact for Most Vulnerable SNP and High-Risk patients, ensuring they received specialized services to meet their health goals and prevent future hospital admissions. • Supported Social Workers completing Chronic Social Work Assessments with High-Risk patients, identifying social services needs and providing community resources.

Phoenix, Arizona Area

Worked with District Manager and Healthcare Executives to ensure contractual requirements were met, responded to inquiries on time and developed solutions. Coordinated work with other departments and with State and Federal agencies to expedite claims to resolution. Supervised twelve employees at six hospitals. • Assisted with implementation of new contract at six Abrazo Healthcare hospitals; recruiting, interviewing, hiring, training, and directing staff to meet customer’s needs.• Arranged meetings with Hospital Directors, CFO’s, Case managers, Doctors and Nurses to inform our business procedures and established a referral process to immediately address high priority accounts.• Achieved high productivity from the team through performance reviews, providing feedback and motivating them to be proactive and work independently.

Phoenix, Arizona Area

Provided high quality patient advocacy-based eligibility and enrollment services to uninsured and underinsured patients, including inpatient, outpatient, and emergency department cases at Hospitals, Behavioral Health Centers and Clinics. Received Certification to help navigate the Affordable Care Act. • Analyzed Inpatient and Outpatient hospital census to discover new self-pay cases; screened patients at bedside or home for state and federal program eligibility, completing applications and taking necessary actions to expedite their approvals.• Attended meetings with Case Mangers, Nurses and Doctors, informing of quantity of Medicaid and Federal Disability screenings completed with patients, providing updates and resolution of applications. • Acted as liaison between hospital departments and government agencies, monitoring quantity and quality of claims working independently through completion.