Lorena Andrade Email & Phone Number

Boston, Ma, Us

• Designed and implemented a risk adjustment process to accurately capture patients eligible for facility-based ratings, yielding an additional $4M in revenue, with projection of additional $6M in capitation revenue;• Designed and implemented the Never Assessed Program projected to bring between $4.6-6.8M in revenue through risk adjustment and patient activation. Since its implementation, the program has been consistently generating rating upgrades in 10% of charts reviewed and 20% engagement rate in historically hard-to-reach members;• Collaborated with Market Leaders, Member Retention, Data Platform, and Partner Success teams to validate and optimize tools using Google Sheets and BigQuery to analyze member eligibility files and ensure accuracy regarding their enrollment status and chart creation in alignment with partner expectations and state / federal requirements;• Collaborated in the development and implementation of SOPS and products to enable more effective engagement to meet business needs, compliance requirements, and prioritization criteria for increased ROI and decrease in patient abrasion;• Analyzed enrollment data, trends, and outcomes to identify areas for improvement and develop strategies to enhance patient engagement and onboarding processes;• Acted as liaison, SME, and project manager for leaders, operators, data, and product / tech teams in developing and improving features to enable day-to-day Engagement and Clinical Assessment operations, providing leaders visibility into team's performance, operational health, and program outcomes, while meeting compliance, and regulatory needs;• Operations Lead with 2 indirect reports and mentor to 2 junior staff on service design and reporting development;

• In partnership with tech and data teams, supported the design of the company-standard patient onboarding process, including outreach, completion of a Health Risk Assessment (HRA), and transition to longitudinal care teams;• Based on regulatory requirements, designed and implemented the company's first process of handling the intake, handling, and reporting of complaints & grievances;• Supported the redesign of the company-wide Transition of Care (TOC) process in partnership with clinical leaders, including the independent creation of its reporting tool kit to measure performance, audit readiness, and program outcomes;

• Provided care management services for a panel of up to 100 dual-eligible patients of mild to critical acuity, coordinating LTSS, DMEs, and appointments according with their care plans;• Collaborated with a cross-functional team of operators and clinicians to improve patient’s health outcomes and decrease total cost of care;• Collaborated in ongoing initiatives to promote operational excellence and develop workflows that met contractual requirements.

Sudbury, Ma, Us

Boston, Ma, Us

• Initiate referrals and provide documentation to home care agencies for LTSS services, DME and specialists as requested by clinicians.• Monitor status of referral request and follow-up as necessary to ensure the patient receives service on a timely basis. • Development of SOPs, staff training, and process improvement projects based on company needs.• Work environment with high-volume tasks that often require multitasking and prioritizing. Maintained top productivity and accuracy within my department throughout my tenure.

Mattapan, Ma, Us

• Performed organizational and operational process within the department, and developed training protocol for OBAT Medical Assistants and Registered Nurses at the Hyannis and Plymouth locations;• Developed SOPs to facilitate the workflow and ensure compliance within the OBAT/MAT clinics at the Hyannis and Plymouth locations;• Developed SOPs for screening and treatment of co-occurring infections, such as HCV and HIV;• Coordinated and managed care of patients with HCV;• Maintained patient registry on EIM/ESM, working alongside with entities such as BSAS, DPH, and Boston Medical Center to ensure grant compliance;• Developed and executed outreach events for prospect patients, and built network for post-treatment resources;• Increased MAT patient intake by 110% and retention by 80% within first year of employment;• Nominated by merit to attend to Suffolk University for their Community Health/Community Health Center Management certificate program, sponsored by employee;• Conducted patient intake in the OBAT and Internal Medicine departments as needed;

Mattapan, Ma, Us

• Managed health insurance's prior authorizations, transportation to/from medical appointments, and medication refills; • Coordinated care for perinatal patients and those experiencing transitions of care;• Internal Medicine with Steven Lacy, MD and Jonathan Leviss, MD

Mattapan, Ma, Us

San Francisco, Ca, Us

• Drove profitable sales growth by planning and executing company merchandising direction to drive sales and deliver standard operating procedure execution in the Men, Boys, and Fast Lane's departments (i.e. markdowns, signage, replenishment, and marketing).• Flexed merchandise to drive profitability based on the company's brand's merchandising principles and financial analysis (growth of 7.3% in sales on a 1-million-dollars department within my first year).• Played a critical leadership role within my store, leading both direct and indirect reports to positively impact the team, operations and profitability of the store.

Master Of Science - Ms, Analytics Engineering / Healthcare Informatics

Data Analytics Career Track

Graduate-Level Certificate Program, Community Health And Community Health Center Management

Bachelor Of Science, Public Health

Practical Nursing

Associate'S Degree, Liberal Arts And Sciences, Pre-Nursing

Medical Assistant, Diagnostic Technician, Ekg Technician