Kelvin Peralta Email & Phone Number

❖ Collaborated with the Clinical Research Department, Senior Vice President of I.T., and Legal to share Billing and Research metrics through Power BI with the Sales Team for field demonstrations. Led efforts to implement row-level security, ensuring sales personnel could only access data for their designated territories by coordinating with I.T. on the creation and maintenance of Active Directory groups.❖ Developed a standardized questionnaire that addressed data availability, reporting… Show more ❖ Collaborated with the Clinical Research Department, Senior Vice President of I.T., and Legal to share Billing and Research metrics through Power BI with the Sales Team for field demonstrations. Led efforts to implement row-level security, ensuring sales personnel could only access data for their designated territories by coordinating with I.T. on the creation and maintenance of Active Directory groups.❖ Developed a standardized questionnaire that addressed data availability, reporting capabilities, system accessibility, and error correction processes to evaluate prospective Revenue Cycle Management (RCM) partners. Recommendations based on these findings were presented to the Senior Director of Billing, ensuring informed decision-making regarding potential partners with respect to billing data.❖ Consulted with the Manager of Billing Operations to create logic for identifying claims that required appeals. After outputting the necessary data into SQL-sourced Excel sheets, workflows were developed to run a tailored VBA script which automatically selected and populated a mail merge template with the relevant information from a set of 20 options. ❖ Following a second change to a new PostgreSQL server for CDx laboratory data, the host disallowed custom tables from being housed within the server, reinforcing a previous push from the Billing Operations Analyst role to the use of linked servers as a critical requirement for operations. During this transition, links to the new server were initially established by I.T. via typical ODBC ANSI encoding, resulting in errors that were resolved by urging a connection to Unicode 64 encoding instead.❖ Created video tutorials for new Billing Operations Analysts, thoroughly covering all relevant workflows. These tutorials reduced onboarding time, ensuring new hires became proficient and confident quickly, and refocused time saved from repeating the same training sessions individually to high-priority assignments. Show less

❖ Functioned as the sole billing analyst for 1.5 years in a HIPAA-compliant work environment, delivering accurate and timely ad hoc and month-end reports to senior leadership, including the CFO, Finance Department, Market Access Team, Billing Team, Auditors, Sales, and external partners, ensuring data-driven decision-making and alignment with business objectives.❖ Developed weekly reporting that analyzed large datasets from a combination of payer portals and Revenue Cycle Management (RCM)… Show more ❖ Functioned as the sole billing analyst for 1.5 years in a HIPAA-compliant work environment, delivering accurate and timely ad hoc and month-end reports to senior leadership, including the CFO, Finance Department, Market Access Team, Billing Team, Auditors, Sales, and external partners, ensuring data-driven decision-making and alignment with business objectives.❖ Developed weekly reporting that analyzed large datasets from a combination of payer portals and Revenue Cycle Management (RCM) data into actionable categories for the CFO and Billing Department, which has been continuously refined and used for ongoing decision-making.❖ Played a key role in the 2022 transition to a new RCM business partner by managing the setup and testing of sFTP connections, and creating a crosswalk from past insurance data to new insurance data, allowing cumulative reporting for the Market Access team to retain its structure.❖ Informed the I.T. department about the existence of linked servers for SQL Server Management Studio, preventing the need for migration efforts that would have required moving RCM partner data from one server into a new server which housed CDx laboratory data, hosted by a third party.❖ Provided key patient responsibility metrics (deductibles, copayments, and coinsurance amounts) from payer portals, improving data quality after the 2022 RCM partner transition, and enabling determinations on non-participating insurance billing of patient responsibility.❖ Built a method for capturing payment and denial data directly from Medicare — CDx's highest-grossing insurance plan — which was used to predict payer behavior and improve RCM partner billing accuracy.❖ Created revenue impact reporting for the Market Access team, offering insights to inform decisions on whether to stay out of network with insurance companies or pursue contracts.❖ More accomplishments on resume. Show less

❖ Managed an offshore team in physician and facility data input, ensuring workloads were distributed effectively, and that task assignments were understood.❖ Quickly identified and resolved any discrepancies of work completed by the offshore team by using SQL to compare expected data with inputted data.❖ Collaborated with internal teams to fix website directory errors for Primary Care Providers having multiple addresses, resulting in an improved user experience.❖ Simplified member… Show more ❖ Managed an offshore team in physician and facility data input, ensuring workloads were distributed effectively, and that task assignments were understood.❖ Quickly identified and resolved any discrepancies of work completed by the offshore team by using SQL to compare expected data with inputted data.❖ Collaborated with internal teams to fix website directory errors for Primary Care Providers having multiple addresses, resulting in an improved user experience.❖ Simplified member benefits management by creating identifying members assigned to an invalid Primary Care Provider via SQL, saving 4 labor hours per month.❖ Migrated queries from Microsoft Access to SQL Server Management Studio to apply its larger function repository for use in data analytics. Show less

New York

❖ Collaborated with the engineering team to enhance address matching, halving total work volume for medical claims that had not automatically selected an appropriate existing provider due to address punctuation.❖ Utilized Google's SQL software "BigQuery" to isolate and identify specific claim errors that were not captured by automated systems.❖ Created and shared a SQL-based dashboard for team-wide usage, which allowed for quick claim pricing and rate table data lookups.❖ Enhanced… Show more ❖ Collaborated with the engineering team to enhance address matching, halving total work volume for medical claims that had not automatically selected an appropriate existing provider due to address punctuation.❖ Utilized Google's SQL software "BigQuery" to isolate and identify specific claim errors that were not captured by automated systems.❖ Created and shared a SQL-based dashboard for team-wide usage, which allowed for quick claim pricing and rate table data lookups.❖ Enhanced training by implementing screen and voice recording through QuickTime Player for new hires who presented frequently asked questions that were best answered with a walkthrough.❖ Following managerial approval, enhanced task overviews on a team dashboard by providing a clear area for daily objectives, easy access to commonly used resources, and visual cues which made assignments to individual team members more distinct. Show less

Education record

Education record

Education record