Daniel Agustin Email & Phone Number

San Diego, Ca, Us

San Diego, California, Us

San Diego, California, Us

Develop and improve Quality Development and Incentive Programs for over 300+ providers spanning over 120+ officesServe as an expert in HEDIS measurement, analytics, and reportingProvide interpretation of HEDIS and state technical specificationsIntegration of NCQA Benchmarks and Thresholds to assist in closing care gapsAccess and analyze data from internal and external systems to satisfy internal business and external regulatory requirementsCollaborate with internal partners on regulatory reviews and quality improvement opportunitiesCoordinate the development and management of necessary vendor solutions to support HEDIS requirementsDesign, develop, and deliver operational reports, dashboards (KPI), and ad hoc requestsIdentify opportunities to improve and enhance current reports, increasing value and usabilityStrong analytical and creative problem-solving skillsExperience identifying and communicating data driven insights to internal and external business partnersExcellent PC skills with basic function and strong navigation skills in ExcelResponsible for understanding the clinical and operational implications of measuring core measures, patient satisfaction and utilization managementPerforming necessary database and statistical analyses for evaluating trends in process, resource utilization, patient outcomes, satisfaction levels, cost and functional outcomesProduce descriptive and analytic reports in support of quality improvement programs and develop a thorough understanding of clinical and operational data systems integral to providing analytical support and project management for performance initiativesProvide ad hoc data query and analysis support for hospital end-users that involve clinical interpretation of data (such as diagnoses, procedures, and utilization management)

San Diego, California, Us

Responsible for the creation, implementation and ongoing maintenance of the HIPAA 837 (claims), 835 (remittances), 276/277 (claims status inquiry and response) EDI transactions and any other EDI transactions as necessitated, all paper claim formats (HCFA & UB04) and claim edits to ensure quality claims.Responsible for planning, implementing and coordinating HIPAA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation.• Knowledge of SQL to create query and generate reports.• Implementation of third-party Electronic Data Interchange (EDI) solutions.• Serve as key contact for internal customers and trading partners.• Communicates with internal resources and trading partners.• Document and analyze current business processes related to EDI.• Develop EDI mapping specifications.• Compare compatibility of EDI related products to company systems and make recommendations.• Create test plans; conduct and manage quality assurance and user acceptance testing.• Coordinate production support for on-going EDI processing.• Provide documentation and follow-up on problem issues.• Provide documentation for software changes and new software.

San Diego, Ca, Us

• Developed procedural documents that improved HTML email marketingcampaign workflow using excel and word mail merge functions• Extensive organization and updating of client and product data using Excel (vlookup and pivot tables) and CRM database systems• Assisted in revision of the digital review process of products using Acrobat and Adobe Digital Editions

• Consistently meeting daily deadlines of verifying and maintaining membereligibility, benefits, option codes, and demographics using EZ-Cap Systems inconjunction with health plan representatives and websites• Generate and process monthly reports of updated member information toensure accurate and up-to-date records of our members in accordance withHIPAA Act• In-loading, eligibility verification, financial analysis, and redirection of claims(Bowman Systems) in adherence to the company’s “100% accuracy”standards

• Consistently meeting daily deadlines of verifying and maintaining member eligibility, benefits, option codes, and demographics using EZ-Cap Systems in conjunction with health plan representatives and websites• Generate and process monthly reports of updated member information to ensure accurate and up-to-date records of our members in accordance with HIPAA Act• In-loading, eligibility verification, financial analysis, and redirection of claims (Bowman Systems) in adherence to the company’s “100% accuracy” standards

San Diego, Ca, Us

• Operated phones and scheduled appointments for the NeurosurgicalDepartment• Created digital versions of patient records, forms, and procedural documents using excel and acrobat in accordance with HIPAA protocols• Assisted with the building transition for the Neurosurgical Department

Us

• Consistently controlled store budget, inventory, and shrink (beneath company’s 2% standards)• Trained/coached employees in tasking, sales, customer service, and the corporation’s pillars/values of success• Responsible for staffing, scheduling, and payroll for over 20 employees• Store annual profits exceeded $1,000,000 multiple years• Increased employee efficiency with new product organization and stocking workflow techniques

Psychology, Chemistry

Business Intelligence Analysis Certificate

Education record

Associate'S Degree, Biology, General