Keyla E. Negrón Díaz

Keyla E. Negrón Díaz Email and Phone Number

Director, Operational Performance at Abarca @ Abarca Health
aventura, florida, united states
Keyla E. Negrón Díaz's Location
Puerto Rico, Puerto Rico
About Keyla E. Negrón Díaz

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

Keyla E. Negrón Díaz's Current Company Details
Abarca Health

Abarca Health

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Director, Operational Performance at Abarca
aventura, florida, united states
Website:
abarcahealth.com
Employees:
317
Keyla E. Negrón Díaz Work Experience Details
  • Abarca Health
    Operational Performance Director
    Abarca Health Mar 2022 - Present
    San Juan, Puerto Rico
  • Mmm Holdings Llc
    Pharmacy Operations Support And Quality Assurance Director
    Mmm Holdings Llc Sep 2019 - Mar 2022
    San Juan, Puerto Rico
    Lead 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.
  • Mc-21 Corporation
    Quality Assurance And Fraud Waste And Abuse Manager
    Mc-21 Corporation Mar 2019 - Aug 2019
    Caguas, Puerto Rico
    Lead 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.
  • Mc-21 Corporation
    Quality Assurance Manager
    Mc-21 Corporation Jan 2013 - Feb 2019
    Caguas, Puerto Rico
    Lead 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.
  • Mc-21 Corporation
    Utilization Analyst - Administrator (Senior Consultant)
    Mc-21 Corporation Jul 2012 - Dec 2012
    Caguas, Puerto Rico
    Prepared 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.
  • Mc-21 Corporation
    Senior Utilization Analyst
    Mc-21 Corporation Oct 2007 - Jun 2012
    Caguas, Puerto Rico
  • Mapfre Puerto Rico
    Actuarial Analyst
    Mapfre Puerto Rico Feb 2005 - Oct 2007
    San Juan, Puerto Rico
    Analyzed 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

Data Analysis Ad Hoc Reporting Queries Hyperion Enterprise Microsoft Excel Cognos Sql Access Sas Hedis Urac Performance Metrics Insurance Customer Service

Keyla E. Negrón Díaz Education Details

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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