Daiaraliz López-Hermina
Dorado
Summary
Acomplished VP of Operations with a progressive background in the healthcare industry and a decisive leadership style. Offers strategic planning skills, experience in financial optimization under forward-looking health models. Ready for challenges and focused on meeting future demands.
Overview
12
12
years of professional experience
Work History
VP of Operations
Physicians Partners Group at Cano Health, LLC
08.2019 - Current
- Participate in the merger of 7 Medical Groups and work on the recruitment of the new provider network.
- Manage a network of more than 8,000 patients for the Medicare Advantage model.
- Achieve the reduction of a deficit of more than 20M to obtain a profitable group, with the implementation of unique strategies in the health industry in our market.
- Collaborate with Health Plan Executives to develop strategic initiatives and long-term goals that positively impact the financial profile of the MSO.
- Developed and negotiated a unique capitation payment model for the MSO.
- Recruit and train contracted personnel and establish delimited functions in the scope of the positions for the organization.
- Identify opportunities to improve business processes flows and employee productivity to meet the goals established according to the requirements of the Health Plan.
- Continually evaluate and adapt processes to optimize revenue performance and maintain compliance with guidelines established by the Health Plan and CMS.
- Lead the development of strategic plans to raise awareness and drive the growth of the MSO population.
- Lead and mentor over 400 physicians and professional assistants through the revenue cycle, providing guidance and support to improve their skills and performance in medical documentation, encounter billing, and practice management.
- Develop a billing system that communicates the doctor with the medical coder, to work recommendations based on compliance with clinical documentation guidelines.
- Develop and execute revenue cycle strategies aligned with CMS payment dates that impact financial goals and organizational objectives.
- Identify opportunities for process improvement throughout the revenue cycle, including but not limited to billing, coding, claims management, and reimbursement.
- Providers profile tracking to assess suggested improvements and develop individualized solution action plans.
- Participated in negotiations of new acquisitions for the implementation of new projects in the market.
- Reduced operational risks by organizing data to forecast performance trends in Medicare Advantage models.
- Implement best practices and innovative solutions to improve efficiency and accuracy in the healthcare ecosystem.
- Apply workflow improvement systems to meet coordinated care measures that affect quality metrics.
- Communicated business performance, forecasts and strategies to investors and shareholders.
CEO
Healthcare BI, LLC
05.2018 - 08.2019
- Creator of a new Entity to provide consulting, administration and education services in health services.
- Managed a Sub-Ipa network to achieve compliance with the quality metrics required by the Medical Plans.
- Established fundamental processes for operations.
- Employees hired, trained and developed in the field of Health, to provide services to primary physicians in accreditation efforts with medical plans, billing processes and medical documentation.
- Managed strategic negotiations with clients through contractual terms agreements for the development of new services and products under a capitated model.
- Built productive relationships with industry partners and competitors to support my clients expansion into new businesses.
- Achieve a sale of the company to promote expanding knowledge to other markets nationwide.
General Manager
Médicos Selectos del Norte / IPA 307 / IPA 20 & Subsidiaries
02.2013 - 04.2018
- Led a work team of more than 30 employees.
- Supervised the different departments such as patient care, nursing, billing and provider care.
- Managed the Medicare Advantage and Medicaid financial models.
- Developed and implemented strategies to retain and increase the membership of more than 100,000 assigned patients in the Medicare Advantage and Medicaid models.
- Implemented a training system for employees, set schedules, and conducted contract negotiations.
- Oversaw financial performance, established budgets, and controlled expenses to provide long-term financial stability and organizational growth.
- Develop new commercial proposals to expand the different services delegated by the Health Plans, such as hospital programs, wound care department, transportation, emergency room, laboratory services and x-rays.
- Developed and maintained relationships with executives and insurance providers through new business development.
- Implemented operational strategies and effectively built the loyalty of medical offices and employees.
- Policies and procedures formulated to streamline operations and achieve NCQA accreditation in different Health.
Financial Advisor
Triple S Management
11.2011 - 01.2013
- Collaborated in the negotiation and contracting process with more than 15 Primary Medical Groups.
- Managed a network of 11 Ipas for the Medicaid model of the Government Health Plan.
- Developed financial profiles to identify opportunity areas of the assigned Ipas.
- Monitored compliance with the processes and protocols established by the Health System.
- Participated in meetings with the Executive Committee of the Health Plan to determine capitated agreements and monitor the financial progress of the assigned Ipas.
Education
MBA - General Management
University of Phoenix
Guaynabo, Puerto Rico05.2009
BBA - Marketing
American University
Bayamón, Puerto Rico05.2007
Skills
- Portfolio Management
- Leadership and People Development
- Negotiation and Persuasion
- Raising Capital
- Organizational Structure
- Employee Motivation and Performance
- Growth Portfolios
- Process Optimization
- Executive Leadership
- Corporate Strategy and Development
- Public Speaking
Languages
Spanish
Native language
English
Intermediate
B1
Hobbies
Enjoy my family, swim, paddleboard, run
Timeline
VP of Operations
Physicians Partners Group at Cano Health, LLC
08.2019 - Current
CEO
Healthcare BI, LLC
05.2018 - 08.2019
General Manager
Médicos Selectos del Norte / IPA 307 / IPA 20 & Subsidiaries
02.2013 - 04.2018
Financial Advisor
Triple S Management
11.2011 - 01.2013
MBA - General Management
University of Phoenix
BBA - Marketing
American University
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