Adrian Mora Email & Phone Number

Oakland, CA, US

Foster City, CA

• Manage all capitation, membership, & provider data functions focusing on the accuracy of HMO and ACO revenue and provider capitation disbursements for the organization.
• Responsible for monthly financial cycle performing capitation revenue, membership reconciliations, and variance analysis.
• Reconcile membership to eligibility, prepare budgets, maintain budget to actual reports and support CFO with related Finance duties.
• Responsible for various health plan processes including detailed analysis of capitation revenue, expense, membership, and various other health plan revenue streams.
• Maintain provider databases ensuring integrity of the data to support regulatory submissions of data to health plan partners.

Almeda, CA

• Worked with operations, projects, engineering and support teams and helped shape business objectives and prioritization using a well thought, methodical, data-driven approach.
• Determined requirements, design, builds, tests, implementation and maintenance of ETL processes and.NET applications.
• Developed new processes and/or changes to existing major systems with multiple interfaces across multiple platforms, reviewing technical specifications, writing and reviewing scripts, and preparing documentation.
• Evaluated existing systems for design efficiency and adequate resource utilization to ensure optimal system performance and meet business expectations.

Alameda, CA

• Ensured data accuracy and integrity for all provider data in the transactional database as well as the data warehouse for business intelligence reporting.
• Created T-SQL scripts to generate provider reports for network adequacy, PCP capacity, and provider directories.
• Reviewed the day-today activities of the Provider Data Entry Clerks including training and support for provider data maintenance.
• Ensured completion of monthly, quarterly and annual reports based on requirements from DMHC, MRMIB, and CMS.

Act as a liaison between internal departments and IT. Provide business direction and data analyses for the implementation of new systems. Regularly assist with architecture of data models and user interfaces as well as data validation for new internal applications. Use automation tools to reduce manual repetitive tasks, such as running a report in.

Effectively processed calls in a systematic and organized manner following Call Center scripts, policies and procedures. Worked collaboratively with members and staff across all service lines. Gained extensive knowledge on the four lines of business (Medi-Cal, Healthy Families, Group Care and Complete Care). Gained valuable knowledge while working as a.

Utilized PeopleSoft Version 8.8 to process/maintain/review employee’s seniority date and wage compensation for Northern California employees of Kaiser Permanente which is a well recognized non-profit managed care organization. Audited employees by applying various rules based on the employee’s bargaining unit. Responded collaboratively to employee’s.

Works as a customer service representative for a health insurance plan that provided health care to nearly 100,000 members in Alameda County in the San Francisco Bay Area. Effectively processed calls in a systematic and organized manner following Call Center scripts, policies and procedures. Worked collaboratively with members and staff across all service.

Bachelor'S Degree, Computer Software Engineering, 3.5

Associate In Science And Mathematics, Computer Science, 3.5