Rogelio Osuna, Mba Email & Phone Number

San Diego Metropolitan Area

Responsible for assessing and decreasing risks associated with patient incidents. Work closely with the Quality and Compliance Director and Quality Assurance Manager on improving patient experience through the investigation of their grievances. Develop, implement, and evaluate activities related to improve the PACE participant’s satisfaction and adhere to the CMS quality reporting measures.Responsibilities:- Act as primary investigator for participant grievances and incidents… Show more Responsible for assessing and decreasing risks associated with patient incidents. Work closely with the Quality and Compliance Director and Quality Assurance Manager on improving patient experience through the investigation of their grievances. Develop, implement, and evaluate activities related to improve the PACE participant’s satisfaction and adhere to the CMS quality reporting measures.Responsibilities:- Act as primary investigator for participant grievances and incidents. Conduct an accurate, timely, and comprehensive investigation through root-cause analysis (RCA) of all facts related to the grievance, in order to submit a written response and provide feedback to involved staff. - Promote quality improvement efforts to reduce incidents and follow through with appropriate staff for support, training, and intervention evaluation. - Track and analyze participant grievances and incident reports submitted by staff and stakeholders in order to identify potential participant-related risks and areas of future quality improvement efforts. - Investigate and conduct RCA of all incidents that meet the criteria for RCA based on CMS guidelines.- Investigate and work with the appropriate teams to ensure a corrective action is developed for all incident reports received. - Conduct periodic and annual trainings for all staff on risk management related topics. Show less

San Diego, California, United States

Assist the Quality and Compliance Director and QA Manager in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program, including annual review and update of the quality improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, education and training of program staff around quality improvement, preparation of routine and special reports, and coordination of improvement efforts… Show more Assist the Quality and Compliance Director and QA Manager in all activities related to the PACE (Program of All-Inclusive Care for the Elderly) Quality Management Program, including annual review and update of the quality improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, education and training of program staff around quality improvement, preparation of routine and special reports, and coordination of improvement efforts arising from monitoring activities.Responsibilities:- Attend IDT morning meetings regularly and stay updated on the issues/discussions brought up by IDT disciplines. - Gather all data for quality reporting and enter data into the HPMS system. Assist with aggregating and analyzing HPMS indicators.- Review electronic medical records for data collection, investigation purposes, and for medical records quality checks. - Assist with the development of the organization’s Quality Improvement (QI) Program.- Identify opportunities for Quality Improvement initiatives and assist the Quality Senior Management in developing and tracking plans of action for improvement processes.- Maintain knowledge of policies and procedures and perform in accordance with applicable regulatory requirements, external laws, and accreditation standards as they relate to PACE and Quality Assurance.- Stay up-to-date with the most current Federal and State regulations related to PACE. Show less

San Diego, California, United States

Responsible for the initial screening and coordination of new participants to the San Diego PACE (Program of All-Inclusive Care for the Elderly) program. Responsible for working with the PACE Marketing Manager to implement the program’s intake, enrollment, outreach, and marketing activities.Responsibilities:- Conducted San Diego PACE program eligibility screening, intake, education, and enrollment assistance activities to determine participant… Show more Responsible for the initial screening and coordination of new participants to the San Diego PACE (Program of All-Inclusive Care for the Elderly) program. Responsible for working with the PACE Marketing Manager to implement the program’s intake, enrollment, outreach, and marketing activities.Responsibilities:- Conducted San Diego PACE program eligibility screening, intake, education, and enrollment assistance activities to determine participant needs and eligibility for enrollment.- Coordinated communications of eligibility decisions, approvals or disapprovals with participant or their family members.- Provided tours of PACE centers to interested family members, potential participants, community partners, and providers.- Participated in the interdisciplinary team (IDT), management team, and other related meetings and activities.- Conducted public outreach and education activities to ADHC, SYHC patients, and community members at clinic locations and other community locations about PACE and other related health coverage options.- Assisted Senior Management in hiring activities including candidate screening and interview process. Show less

Tijuana, Baja California, Mexico

Responsible for verifying patient's dental insurance benefits and eligibility to ensure timely reimbursement. Serve as a liaison between patients and their US dental insurance companies.Responsibilities include:- Establish relationships and maintain open communication with third party payors.- Responsible for claim processing and resolve any claim rejections. - Manage the clinic's credentialing process with US dental insurance companies and contracted networks.-… Show more Responsible for verifying patient's dental insurance benefits and eligibility to ensure timely reimbursement. Serve as a liaison between patients and their US dental insurance companies.Responsibilities include:- Establish relationships and maintain open communication with third party payors.- Responsible for claim processing and resolve any claim rejections. - Manage the clinic's credentialing process with US dental insurance companies and contracted networks.- Responsible for renewing the clinic's malpractice insurance and ensure proper coverage. Show less

Mexico City Area, Mexico

Responsable for overseeing the management of 4 short-term rental properties in the historic center of Mexico City.

Chula Vista, Ca

Responsible for the supervision of the IHA Outreach Specialists. Conduct weekly and monthly audits to ensure accuracy and compliance. Provide guidance to staff regarding priorities, IHA scheduling, proper documentation and coding. Control performance benchmarks and timeliness by monitoring telephone calls and reviewing multiple reports.Responsibilities:- Manage and coordinate the work activities of the IHA Outreach Specialists, provide technical advice and the necessary training to… Show more Responsible for the supervision of the IHA Outreach Specialists. Conduct weekly and monthly audits to ensure accuracy and compliance. Provide guidance to staff regarding priorities, IHA scheduling, proper documentation and coding. Control performance benchmarks and timeliness by monitoring telephone calls and reviewing multiple reports.Responsibilities:- Manage and coordinate the work activities of the IHA Outreach Specialists, provide technical advice and the necessary training to facilitate continuous improvement of the employees.- Ensure the accuracy and integrity of risk adjustment data submitted to CMS.- Attend and facilitate department meetings and one-on-one feedback sessions with each staff member.- Assist in implementing health management activities in accordance with regulations, contract standards, and compliance.- Participate in continuous quality improvement activities including live call and recorded call monitoring to ensure the accuracy of information and the quality of customer service provided by the staff.- Work closely with clinic staff in identifying areas requiring policies and procedures, policy development, and periodic policy review. - Maintain department’s corporate practices, documentation, work instructions, filling and record retention. Show less

Chula Vista, Ca

Ensured that enrollment processes were accomplished in a timely and efficient manner. Made recommendations for system and process enhancements to improve data accuracy. Provided training to users and new employees on eligibility processes and functionalities. Created and managed the content of all customer marketing materials.Responsibilities:- Maintained enrollment data integrity while cognizant of applicable data availability timelines.- Researched all significant laws and… Show more Ensured that enrollment processes were accomplished in a timely and efficient manner. Made recommendations for system and process enhancements to improve data accuracy. Provided training to users and new employees on eligibility processes and functionalities. Created and managed the content of all customer marketing materials.Responsibilities:- Maintained enrollment data integrity while cognizant of applicable data availability timelines.- Researched all significant laws and regulations by reviewing and monitoring regulatory bulletins and other sources of information including government websites such as the Centers for Medicare & Medicaid Services, Department of Managed Health Care, Department of Health Care Services, Health Plan Management System, and Medi-Cal.- Supervised all vendor material translations and transcriptions to ensure quality, consistency, and on-time delivery.- Coordinated the timely and accurate processing of all member mailings; including marketing materials, monthly newsletters, and other customer communications.- Worked closely with the Compliance Department and the Chief of Regulatory and Legal Affairs, to ensure that all customer, legal, and marketing materials complied with state and federal regulations. - Conducted testing, eligibility updates and system setup to ensure high quality data.- Worked closely with Software Engineering, Information Systems, and other key departments on eligibility operations and functionality.- Completed other compliance tasks assigned by the Compliance Manager or Chief.- Initiated, maintained, and managed multiple vendor relationships. Show less

Chula Vista, California, United States

Provided assistance to customers, providers, and potential members regarding eligibility, benefits, and solving any issues related to their health needs.Responsibilities: - Clearly and effectively explained benefits, eligibility, claim status, guidelines, and services both to members and providers.- Adhered and met all productivity service levels in the department.

Chula Vista

Responsible for accurately maintaining accounts payable and recovering any over-payment of funds.Responsibilities:- Accurately processed and analyzed electronic claims for Medicaid and Medicare lines of business.- Researched and processed second payer claims, coordination of benefits, coverage and adjudication.- Applied Medicare and Medicaid claim policies and procedures accordingly.

Master Of Business Administration (Mba), Business Administration And Management, General

Bachelor Of Arts (Ba), Graphic Design