David Chavez Email & Phone Number

Escondido, CA, US

San Diego, California

• Leads audits related to high profile and complex health plans.
• Facilitates and leads internal and external meetings acting as owner of information. Including the creation and distribution of meeting agendas, kicking off the discussion with a high level overview and purpose of the.
• Facilitates and leads internal and external meetings acting as owner of information. Including the creation and distribution of meeting agendas, kicking off the discussion with a high level overview and purpose of the.
• Proactively engages internal business owners and subject matter experts to effectively manage internal and external customer expectations.
• Actively participates in collaborative team environment to educate, coordinate activities and resolve unique problems with recommended course of action to internal stakeholders.
• Uses best efforts to acknowledge receipt of emails from clients within 24 hours of receipt.

San Diego

• Understanding of Prescription Drug Event (PDE) edit resolution, roles and responsibilities across the organization. Analyzes and reconciles PDE entries rejected by CMS, including rejections related to eligibility and.
• Manages PDE file generation process from end to end. Including cycle generation, executing PDE load and extract programs, file quality… Show more
• Manages PDE file generation process from end to end. Including cycle generation, executing PDE load and extract programs, file quality control, file submission to CMS or clients. Executes the retrieval and processing.
• Demonstrates knowledge of PDE reporting requirements including comprehensive understanding of the PDE and Medicare DDPS response file layout.
• Maintains current understanding of assigned client’s Medicare Part D benefit plans in order to analyze the accuracy of PDE records prior to submission.
• Establishes positive working relationships with internal and external clients by providing sustainable, measurable, accurate, reliable and timely execution of PDE data tasks. Delivers solution-oriented problem solving.

Greater San Diego Area

• Technical analyst within testing and validation and other internal departments including benefits configuration, pharmacy network configuration, client implementation and account management.
• Responsible for the development of testing strategies, developing specifications of business requirements and collaborative involvement with other departments to enhance core testing infrastructure to ensure flawless.
• Acquired a thorough understanding of system logic for… Show more
• Acquired a thorough understanding of system logic for claims adjudication, system constraints, conflicting benefit logic configurations, design to ensure design satisfies intended solution.
• Ensures consistent customer satisfaction by proactively assuming a leadership role through consultation and collaboration with external clients, client team members, to ensure that business requirements for benefit.
• Day to day responsibilities include research, quality assurance, analysis and test development specifications.

Greater San Diego Area

• Develop and prepare system specifications for assigned system applications for implementation by IT Program developers.
• Gather and translate general business requirements.
• Serve as a liaison between the Business Owners and Development team for existing, new programs, applications, functions, and user requirements.
• Perform research to gather necessary information and prepares analysis of data.
• Work directly with manager and BA team members to implement system… Show more
• Work directly with manager and BA team members to implement system changes.

Greater San Diego Area

• Monitor, verify and update information on submitted claims.
• Perform quality review by comparing claim form to claim information entered into the claims payment system.
• Visually review claims correspondence including explanation of benefits (EOB), clinical treatment forms (CTF) and referrals to verify appropriate data to be entered for coordination of benefits. Make necessary.
• Visually review charges, determine if claim… Show more
• Visually review charges, determine if claim is payable or if additional information is needed, access the computer system and utilize denial codes and/or type denial letters/correspondence, within established.
• Assisted other claims teams and departments as needed. Show less

Greater San Diego Area

• Enter data from Claim Forms into the claims processing system
• Responsible for the accurate review, input and adjudication of claims in accordance with regulations, departmental policies, procedures, and contractual obligations of the organization.
• Provides assistance to supervisors and examiners. Assists in training of new claims personnel by providing error feedback.

Greater San Diego Area

• Responsible for completing corporate processing requests, fulfillment requests, and package handling services.
• Performs daily mail assembly and fulfillment activities as assigned. Handles shipments and deliveries, assists with claims, returned mail, and inter office deliveries. Assists with inventory cycle counts and kit prep.
• Responsible for quality control in all aspects of assembly and mail prep. Prepares Fulfillment requests for shipping or mailing following quality control… Show more
• Responsible for quality control in all aspects of assembly and mail prep. Prepares Fulfillment requests for shipping or mailing following quality control processes. Assists shipping and receiving duties.
• Assists with inventory and weekly cycle counts.
• Provides direct support as needed to assure daily corporate requests are processed timely. Show less

Greater San Diego Area

• Processed, routed and confirmed daily shipment of data to account holders.
• Filed received data in central library in an accurate serialized manner.
• Accurately converted alpha/numeric data into the company’s proprietary software program to generate a schedule of account holders shipping and receivables.
• Audited data storage received and reported discrepancies to management.
• Provided customer service on follow-up services, complaints, and/or to assist in the preparation… Show more
• Provided customer service on follow-up services, complaints, and/or to assist in the preparation of a disaster recovery plan.

Project Management Certification Program (Pmcp), Project Management

B.S. Information Technology, Business Systems Analysis

Transfer Studies

Activities and Societies: Associated Student Government