Ruffy-John Costales, Css, Cts Email and Phone Number
Honolulu, HI, US
Ruffy-John Costales, Css, Cts's Location
Aiea, Hawaii, United States, United States
Ruffy-John Costales, Css, Cts's Contact Details
Ruffy-John Costales, Css, Cts work email
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Ruffy-John Costales, Css, Cts personal email
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About Ruffy-John Costales, Css, Cts
As a Project Coordinator for Utilization Management at Agilon MSO Hawaii, I apply my 13 years of experience in the healthcare industry to support the delivery of high-quality and cost-effective care for patients and providers. I hold certifications in Customer Service, Project Management, and Lean Six Sigma, which demonstrate my commitment to excellence, efficiency, and continuous improvement.My core competencies include patient administration, office operations, and team building. I manage patient records, process referrals, and coordinate with internal and external contacts for billing purposes. I also work with peers, clients, and management to ensure clear and timely communication and collaboration. Additionally, I provide training and support to my team members, fostering a positive and productive work environment. My mission is to leverage my skills and expertise in Customer Service, Quality, and Utilization Management to enhance the performance and outcomes of Agilon MSO Hawaii and its partners.
Ruffy-John Costales, Css, Cts Work Experience Details
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Program Specialist; Quality ManagementHmsaHonolulu, Hi, Us -
Program Specialist; Health System Development - Quality ManagementHmsa Feb 2024 - PresentHonolulu, Hawaii, United States
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Project Coordinator; Utilization ManagementAgilon Mso Hawaii Dec 2023 - Feb 2024Honolulu, Hawaii, United States- Efficiently processed specialty and prior authorization requests, ensuring accuracy and compliance with clinical review standards.- Collaborated with department leadership to successfully execute special projects, demonstrating strong teamwork and communication skills.- Managed and facilitated various special projects, providing clear updates on project progress to department leadership.- Conducted audits and analyzed data, meeting contractual requirements with insurance payors, showcasing a commitment to data integrity and adherence to contractual obligations.
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Project Coordinator; Utilization ManagementAgilon Health Jan 2023 - Nov 2023Honolulu, Hawaii, United States- Efficiently processed specialty and prior authorization requests, ensuring accuracy and compliance with clinical review standards.- Collaborated with department leadership to successfully execute special projects, demonstrating strong teamwork and communication skills.- Managed and facilitated various special projects, providing clear updates on project progress to department leadership.- Conducted audits and analyzed data, meeting contractual requirements with insurance payors, showcasing a commitment to data integrity and adherence to contractual obligations. -
Intake CoordinatorOahu Home Healthcare Llc Sep 2022 - Dec 2022Honolulu, Hawaii, United States- Maintained accurate patient records through effective coordination with internal and external contacts, ensuring seamless billing processes.- Evaluated the organization's capacity to meet patient and referral source needs by responding promptly and appropriately to all incoming calls.- Streamlined the admission process by efficiently processing new patient referrals for home health services, demonstrating a commitment to responsive and organized intake procedures.
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Intake SchedulerOahu Home Healthcare Llc Sep 2021 - Sep 2022Honolulu, Hawaii, United States- Proactively resolved scheduling challenges through effective collaboration with clinical staff and patients, ensuring smooth and efficient operations.- Evaluated the organization's capacity to meet patient and referral source needs by responding promptly and appropriately to all incoming calls, showcasing a commitment to customer service.- Achieved a milestone of scheduling 45 admissions in one week by fostering strong teamwork and communication among all staff members, highlighting efficiency and coordination skills.
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Customer Resolution Associate; Nia Clinical And Service OperationsMagellan Health Jun 2021 - Sep 2021Honolulu, Hawaii, United States- Facilitated timely resolution of authorization problems by conducting thorough research and applying effective solutions, enhancing customer satisfaction.- Investigated and resolved written/verbal complaints related to authorizations, showcasing strong problem-solving skills in handling complex issues with both customers and providers.- Monitored and identified trends in authorization problems, collaborating with internal departments to proactively address and resolve issues, demonstrating a commitment to continuous improvement.- Successfully resolved cases in the queue related to member eligibility, provider verification, imaging provider verification, redirection, and retro reviews, ensuring efficient case management and resolution. -
Quality Practice Assistant I; Clinically Integrated Physician NetworkThe Queen'S Medical Center Dec 2019 - Mar 2021Honolulu, Hawaii, United States- Monitored workflow and provided technical expertise to ensure Quality Practice Assistant (QPA) IIS administrative functions aligned with quality improvement goals for the Physician and Medicare Shared Savings Program Accountable Care Organization.- Coordinated quality improvement initiatives with QPA IIS for assigned practices, demonstrating a commitment to enhancing healthcare quality.- Served as a liaison between the QPA team and various health system functions, fostering seamless collaboration and communication to support overall quality objectives.- Orchestrated the promotion of clinical programs, established efficient workflows in assigned practices for optimal referral facilitation based on evidence-based guidelines.- Ran registries to identify patients for referral into clinical programs, contributing to targeted and proactive patient care interventions. -
Quality Practice Assistant Ii; Akoakoa Physician OrganizationThe Queen'S Medical Center Dec 2018 - Dec 2019Honolulu, Hawaii, United States- Offered administrative assistance and support to multiple employed and independent Primary Care Physicians within the Queen’s Clinically Integrated Physician Network.- Played a key role in quality improvement initiatives for the Physician Organization and Medicare Shared Savings Program Accountable Care Organization.- Demonstrated adeptness in coordinating and facilitating initiatives that enhanced healthcare quality and contributed to the organization's clinical integration efforts.- Maintained efficient support for Primary Care Physicians, ensuring smooth collaboration and alignment with quality improvement goals.- Operated within the framework of the Queen’s Clinically Integrated Physician Network, contributing to the success of the organization's accountable care initiatives.
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Sales AssociatePier 1 Sep 2018 - Jan 2019Honolulu, Hawaii -
Coordinator, Office Operations; Clinic OperationsHawaii Pacific Health Feb 2017 - Oct 2018Honolulu, Hawaii, United States- Efficiently coordinated and managed inventory for office supplies and equipment within the department, ensuring seamless operational support.- Spearheaded travel arrangements for the department director, physicians, and staff, optimizing time and resources for a smooth travel experience.- Demonstrated strong organizational skills by scheduling and maintaining calendar appointments for both the department director and staff, enhancing overall workflow efficiency. -
Patient Service Representative; ImagingHawaii Pacific Health Dec 2015 - Feb 2017Honolulu, Hawaii, United States- Facilitated effective communication with departmental staff, swiftly resolving issues and concerns to maintain a collaborative work environment.- Enhanced the patient experience by ensuring a welcoming check-in process for appointments, promoting a positive and patient-centric atmosphere.- Played a key role in patient care coordination by scheduling and educating patients in preparation for exams and procedures, contributing to a smooth healthcare delivery process.- Upheld data accuracy and compliance by reviewing and confirming patients' demographic and insurance information, ensuring up-to-date and accurate records.
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Customer Care Supervisor; Medicare Part-DXerox May 2015 - Dec 2015Honolulu, Hawaii, United States- Mentored and trained employees, elevating team performance and fostering a culture of continuous learning and professional growth.- Championed a commitment to excellent customer service, enhancing overall patient and stakeholder satisfaction.- Demonstrated solid de-escalation skills, effectively managing challenging situations and ensuring a positive experience for all involved.- Managed employee personnel records, contributing to organized and compliant human resources practices within the organization. -
Quality Assurance Associate; Medicare Part-DXerox Nov 2012 - May 2015Honolulu, Hawaii, United States- Provided functional guidance, training, and assistance to staff, enhancing team capabilities and fostering a collaborative work environment.- Conducted audits and analyzed data to identify areas for performance improvement, contributing to data-driven decision-making and operational excellence.- Evaluated process improvements to ensure compliance with standards and regulations, promoting efficiency and adherence to best practices.- Verified data and information for accuracy, maintaining high standards of data integrity and reliability within the organization.
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Customer Care Assistant; CommercialXerox May 2012 - Nov 2012Honolulu, Hawaii, United States- Successfully resolved telephone inquiries and complaints, showcasing strong customer service skills and problem-solving abilities.- Achieved first-call customer resolution by providing appropriate options and solutions, enhancing overall customer satisfaction.- Maintained accurate documentation of telephone inquiries and complaints in relevant systems, ensuring a comprehensive record for future reference.- Educated customers about prescription benefits and program availability, contributing to informed decision-making and improved customer understanding.
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Service Administration ClerkPacific Wireless Communications Sep 2008 - May 2012Honolulu, Hawaii, United States- Efficiently handled inbound complaint resolution, demonstrating a proactive approach to addressing customer concerns and ensuring satisfaction.- Scheduled service orders for technicians, optimizing workflow and facilitating timely service delivery.- Processed completed service orders for the service department, contributing to streamlined operations and accurate record-keeping.- Managed the processing of purchase order requests, demonstrating attention to detail and adherence to procurement procedures.- Performed service department ordering, ensuring the availability of necessary supplies and equipment for smooth operations.- Organized and facilitated the shipping out of all units for repair, managing logistics and maintaining effective communication.- Provided valuable additional support for Customer Service Representatives, contributing to a collaborative and responsive team environment. -
BaristaStarbucks May 2006 - Aug 2008Kapolei, Hawaii, United States• Assist customers with questions about bakery products or merchandise• Restock retail items according to corporate schematics• Detailed cleaning tasks• Assembling espresso beverages according to company standards
Ruffy-John Costales, Css, Cts Skills
Customer Satisfaction
Training
Documentation
Microsoft Office
Outlook
Quality Assurance
Microsoft Word
Powerpoint
Microsoft Excel
Sales
Program Management
Team Building
Leadership
Management
Time Management
Data Entry
Customer Service
Team Leadership
Teamwork
Public Speaking
Patient Administration
Patient Scheduling
Patient Registration
Patient Satisfaction
Patient Advocacy
Microsoft Outlook
Customer Experience
Health Insurance
Medicare
Medicare Prescription Drug Plans
Radiology
Healthcare
Office Operations
Ruffy-John Costales, Css, Cts Education Details
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Health Management -
Business - Healthcare Management -
Heald College-HonoluluBusiness Administration/Sales & Marketing
Frequently Asked Questions about Ruffy-John Costales, Css, Cts
What company does Ruffy-John Costales, Css, Cts work for?
Ruffy-John Costales, Css, Cts works for Hmsa
What is Ruffy-John Costales, Css, Cts's role at the current company?
Ruffy-John Costales, Css, Cts's current role is Program Specialist; Quality Management.
What is Ruffy-John Costales, Css, Cts's email address?
Ruffy-John Costales, Css, Cts's email address is rc****@****are.com
What schools did Ruffy-John Costales, Css, Cts attend?
Ruffy-John Costales, Css, Cts attended University Of Phoenix, Western Governors University, Heald College-Honolulu.
What skills is Ruffy-John Costales, Css, Cts known for?
Ruffy-John Costales, Css, Cts has skills like Customer Satisfaction, Training, Documentation, Microsoft Office, Outlook, Quality Assurance, Microsoft Word, Powerpoint, Microsoft Excel, Sales, Program Management, Team Building.
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