Loretta Cortez Email and Phone Number

CCA document design and configuration Testing of program updates and patches Configuration migration to higher environments Security audits and gap analysis

Analyze healthcare data to identify trends in population, coverage, and payment activity. Create uniform documentation of departmental processes.Trouble-shoot to identify process gaps, errors, and compliance failures. Serve as subject matter expert for department.

Expanding my skills in Data Analystics and Visualization, including VBA, Python, Pandas, SQL, PostgresSQL, MongoDB, Machine Learning and Big Data.

As Director of Enrollment Services, responsibilities include:* Overseeing and coordinating all aspects of member enrollment/termination from their Active or COBRA insurance plans managed by BMA. * Overseeing all EDI connections with various groups, brokers and services to facilitate transmission of eligibility and claims information. * Production of PBM Accumulator reporting. * Oversee all Carrier COBRA reports to ensure timely update of member records. * Review membership for Overage Dependents and ensure appropriate notifications to member and group. * Review COBRA memberships for required terminations to remain within legal compliance. * Process COBRA premium payments to ensure member enrollment is properly maintained and carrier records are updated. * Coordinate and manage IT tickets to monitor progress and ensure projects are moving. * Supervise Enrollment Team.

Develop reports to analyze critical business trends, implement effective and efficient solutions to known deficiencies in revenue cycle, identify and implement process redesign to ensure operational efficiency. Assist in implementing standard processes and procedures for capturing patient demographic and charge data, maintain control of and update master files within organization, coordinate exam code dictionaries, maintain contract file summaries and oversee Data Review and Analysis department.

Staywell purchased Lifemasters, and I continued in my role of operational reporting for Disease Management sector performance. I also was instrumental in introducing performance reporting for Lifestyle sector, to include monthly operational reporting, and development of Key Indicator report for metrics that have been identified as critical to monitoring success. I also helped in developing a Segment Profitability analysis that helped leadership to understand, by client, the profitability of various programs. Eventually, my position was transitioned to Finance team, where I provided a monthly Financial Scorecard and Monthly Key Indicator Report that included contributions from various department across company.

In this role, I was responsible for operational reporting for leadership and Executives. In order to accomplish this, I developed a model for analyzing cost/revenue potential for various service models based on client-specific demographics, developed a monthly Dashboard that tracked performance metrics, developed Participation analysis, cross-referencing pricing models, to monitor opportunities in revenue generation and performance gaps, developed and maintained movement analysis reports to understand participant performance within LM programs, developed and maintained Monthly Performance Reports for 50+ clients that show performance to goal in key metrics, contract measures and operational initiatives, developed and maintained weekly reports for new client implementations to ensure goals are achieved within pre-determined timelines

In my role at The Scooter Store, I used my statistical and analytical skills to develop appropriate strategies for penetrating local markets, analyze and report performance of marketing campaigns (Direct Mail, DRTV, Print, and other channels), make recommendations for performance improvement, cost reduction, campaign strategy, list selections, and implement data integrity improvements, data acquisition, etc. I also developed Customer and Responder models, performed Trend Analysis, coordinated development of predictive models to improve campaign targeting and monitored response and conversion curves to modify campaigns as needed. I also supported New Business Development in terms of performance reporting and process development.

In my role at Checks in the Mail, I championed and/or implemented process improvements that resulted in $1.1 million in savings in 2001, managed all distribution processes, including logistics, to ensure customer products were delivered in a timely and cost-effective manner, and managed an annual delivery budget of $9 million. When wearing my engineering hat, I did Project Management, conducted time studies to establish standards for various departments, and calculated manning requirements based on standards and business volume.As Safety Coordinator, it was my responsibility to monitor and ensure company remained in compliance with all OSHA standards, and develop a company safety program, to include a Hearing Conservation Program and a PPE Program. I also had to oversee and document all safety training and ensure required certifications are renewed annually (or as needed), and maintain all safety-related documentation for OSHA audits.

While completing my BS in Mathematics with Concentration Statistics, I interned at USAA as an analyst assigned to Competitive Analysis Unit and Financial Actuary Unit. In that role, I worked with HOCS program (Homeowners Competitors System) entering homeowner policy rating information, wrote algorithms for calculating competitor rates, utilized algorithms to ensure all rates calculating correctly and all data entered correctly, reconciled end-of-month reports, assisted in updating Financial spreadsheets for monthly and quarterly reporting, and assisted in analyzing catastrophic hurricane claims vis-à-vis geographic locations.

Princeton functioned as the corporate office for Greenway Park Medical Group, and in December 1994 I transferred to this office. In my role as Data Analyst, I was responsible for designing and maintaining a database containing patient hospitalization and nursing home admissions, then utilize this database to cross-reference with medical claims payments, resulting in additional revenue of $500,000. I also assisted in tracking Durable Medical Equipment, developed a plan for an employee daycare center, and planned and chair monthly Managed Care Department meetings for all clinics.

In this role, I supervised a staff of 20 to include front office, switchboard and medical records, and medical information coordinators, registered patients, coordinated physician schedules and worked as liaison with insurance companies; processed referrals for medical services or equipment; prepareed patient charts and agenda for weekly staffing; and tracked all Durable Medical Equipment. I also researched outstanding claims and performed general supervisory duties including calculating time cards, tracking sick leave and vacations, and providing input for employee reviews.