Keyla E. Negrón Díaz Email and Phone Number
A growing career over the past 19 years, comprised of a diversity of roles in the health industry, contributing in each position to the strengthening of analysis processes, feasibility studies and reporting, which are key to both decision-making and strategy development. This led to the opportunity to take on a managerial role within a short period of time, which has been characterized by an ability to form a firm structure with a focus on continuous improvement. A leader who is passionate about sharing knowledge and fostering learning by forging highly competitive groups. *Strategic management of a quality department with a high volume of transactions.*Experience in a variety of insurance products: health, life and disability.*Validation of plans and forms to ensure regulatory adherence.*Knowledge of programming, which is key to monitoring related projects.*Automation of processes for efficiency and visibility of information.*Updating of systems to adapt to changes in requirements.*Design of tools that guarantee service during emergencies.*Assessments involving statistical and financial data.*Company representative in audits and on other assignments.*Development of policies, guidelines and procedures.*Promotion of synergy and consensus with other groups (inside and outside).*Coordination of functions with multidisciplinary teams.*Experience in providing training, talks and teaching.*Lean Yellow Belt CertificationSPECIALTIES:Validation Projects, Utilization / Actuarial Analysis, Forecast, Math & Statistics, Budgeting and Planning, Business Intelligence Tools, Metrics, KPIs, Dashboards, Regulatory Compliance, Accreditation Processes, Internal Audits, Quality Reviews, Technical Writing, Team Coaching, Public Speaking
Abarca Health
View- Website:
- abarcahealth.com
- Employees:
- 317
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Operational Performance DirectorAbarca Health Mar 2022 - PresentSan Juan, Puerto Rico -
Pharmacy Operations Support And Quality Assurance DirectorMmm Holdings Llc Sep 2019 - Mar 2022San Juan, Puerto RicoLead the Pharmacy Quality Assurance and Back End Pharmacy Operations Teams that manage (annually) over 30 projects and company initiatives, over 70 audits and monitoring (internal and external), over 100k test claims, over 300k claims review, 600 reports, resolve over 12k PDE records and identify more than 18K claim to recoup within a company dedicated to providing services related to health care to the Medicare and Medicaid population of Puerto Rico. Oversee projects for compliance with the Puerto Rico Department of Health, Puerto Rico Insurance Commissioner, CMS, ASES, NCQA and HEDIS. Ensure adherence to contractual agreements. Lead a team of 9 associates and 2 supervisors. -
Quality Assurance And Fraud Waste And Abuse ManagerMc-21 Corporation Mar 2019 - Aug 2019Caguas, Puerto RicoLead the Quality Assurance, Pharmacy Audit and Fraud, Waste and Abuse Departments that manage over 2,500 validations for implementations (creation and/or changes to formularies and pharmacy benefit plans) in QA and over 200k pharmacy claims reviews for Pharmacy Audit and FWA, within a company dedicated to administrating pharmacy benefits, clients include: Triple S, MAPFRE, MCS, Constellation Health, PR Government Health Plan, MMM Healthcare, JAI Medical, Health Plan of San Joaquin and Connective Rx; Direct groups: Banco Popular, Bristol Myers and MMM Healthcare Employees, Walmart, Edward Lifesciences among others. Oversee projects for compliance with the Puerto Rico Department of Health, Puerto Rico Insurance Commissioner, CMS, HRSA, HEDIS, OIG and URAC. Ensure adherence to contractual agreements. Expense Budget: $500K+; lead a team of 15 associates and 1 supervisor. -
Quality Assurance ManagerMc-21 Corporation Jan 2013 - Feb 2019Caguas, Puerto RicoLead the Quality Assurance Department that manages over 2,500 validations for implementations (pre and post), changes to formularies or plans (new or existent), within a company dedicated to medication coverage, administering formularies and pharmacy claim processing. Clients include: Triple S, MAPFRE, Constellation Health, Plan de Salud del Gobierno and MMM Healthcare; Direct groups: Banco Popular, Bristol Myers and MMM, among others. Oversee projects for compliance with the Puerto Rico Department of Health, CMS and HRSA. Ensure adherence to contractual agreements. Expense Budget: $250K+; lead a team of eight to ten associates. -
Utilization Analyst - Administrator (Senior Consultant)Mc-21 Corporation Jul 2012 - Dec 2012Caguas, Puerto RicoPrepared statistical reports (internal, client and regulatory), drug trends, reports to CMS, and RFPs; performed utilization analysis and cost-effective strategies for clients (Step Therapy, Duplicate Therapy, Contraindicated Therapies). Identified possible fraud, waste and abuse patterns, during an accelerated growth period in key clients: Triple S, PSG and Edwards Life Sciences. -
Senior Utilization AnalystMc-21 Corporation Oct 2007 - Jun 2012Caguas, Puerto Rico -
Actuarial AnalystMapfre Puerto Rico Feb 2005 - Oct 2007San Juan, Puerto RicoAnalyzed the experience, estimate risk and recommended renewal rates, prepared and reviewed loss ratio report for different group benefits including: life, short and long-term disability (STD, SINOT y LTD), mortgage life, accidents (GAP and SAP) and health. Prepared reserve estimates, incurred but not reported (IBNR) claims. Prepared utilization reports of drug and health benefits for insured groups and statistical reports for local and corporate offices and government agencies.
Keyla E. Negrón Díaz Skills
Keyla E. Negrón Díaz Education Details
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Finance, General -
Mathematics
Frequently Asked Questions about Keyla E. Negrón Díaz
What company does Keyla E. Negrón Díaz work for?
Keyla E. Negrón Díaz works for Abarca Health
What is Keyla E. Negrón Díaz's role at the current company?
Keyla E. Negrón Díaz's current role is Director, Operational Performance at Abarca.
What schools did Keyla E. Negrón Díaz attend?
Keyla E. Negrón Díaz attended Inter-American University Of Puerto Rico - Metropolitan Campus, University Of Puerto Rico-Mayaguez.
What are some of Keyla E. Negrón Díaz's interests?
Keyla E. Negrón Díaz has interest in Photography, Theater, Music, Running.
What skills is Keyla E. Negrón Díaz known for?
Keyla E. Negrón Díaz has skills like Data Analysis, Ad Hoc Reporting, Queries, Hyperion Enterprise, Microsoft Excel, Cognos, Sql, Access, Sas, Hedis, Urac, Performance Metrics.
Who are Keyla E. Negrón Díaz's colleagues?
Keyla E. Negrón Díaz's colleagues are Miguel A. Collazo Rodriguez, Alejandra Sánchez Miranda, Liza Monero-Torres, Scott Reed, Michelle Morales, Patrick White, Cfe, Johanna Calderón.
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