Lysmar Vázquez González
Bayamón
Summary
Professional with more than 15 years of experience working for one of the most innovative companies in the health insurance. Driven by a strong background in healthcare quality improvement, excel in strategic planning and stakeholder engagement, leveraging expertise in CMS regulations, Five-Star Quality Rating Program, HEDIS, CAHPS and HOS campaing. Known for outstanding problem-solving abilities and teamwork, I've significantly enhanced customer loyalty and operational efficiency, demonstrating exceptional communication skills and bilingual proficiency.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Mgr II Cx Engagement and Coordination of Care Unit
IPA Holdings, LLC
01.2023 - Current
- Accountable for strategic planning, and relationship management with eternal business associates such as providers, vendors and customer.
- Assumes responsibility for day -to-day operational management of all activities and functions related to the Engagement Department, including IPAs support, Education Initiative, liaison with MMM plan counterparts such as Network Management, Contracting, coding, and staff supervision.
- Responsible for facilitating the ongoing operations necessary to support the members activities with drive improvements in the Quality Customer experience measures based on CMS 5 Star Program.
- Bridges the Gaps in all members that IPA manage. Ensure that each touchpoint across the customer journey is engaging with the Plan, IPA and PCP.
- Responsible to improve Customer loyalty.
- Utilize various data sources and reporting tool to be driven with strategies, planning, executions and results/outcome measures.
- Manage relationship with key stakeholders with Healthplan and MSO.
- Create strategic planning for Annual Enrollment Period, we do so with a great commitment to maintaining the highest level of services excellence for our customer.
- Conduct quality surveys to understand insatisfaction or disenrollment.
- Accomplished multiple tasks within established timeframes.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
Quality Special Project Specialist
Castellana Physician Services, LLC
03.2021 - 01.2023
- Responsible for facilitating the ongoing operations necessary to support the company activities which drive improvements in the Quality Measures based on HEDIS and CMS 5 Star rating program.
- Define a formal Work plan to include Strategies by Area, IPA and special events. The plan need to include KPI and Operational Metrics.
- Has an oversight of the coordination process between IPA Quality Specialist, Coordination of Care Rep and Transition of Care Unit.
- Develop policies/process & which document Quality units(s) initiative.
- Monitor progress on department actions by managing the detailed workplan by Key areas that impact Quality Initiatives Preventive Measures, and providing status reports and formal recommendation to the Network and Clinical Team.
- Audit annual health reports (AHA & CHRA) to evaluate documentation opportunities and compliance with the metrics established by the company.
- Channel and investigate areas of opportunity in discrepancies in star reports with the purpose of maximizing the work performed and achieving the expected results. Lead the quality committee on a monthly basis to present strategies and results by region.
- Attend 5 Star, IPA, Office Staff and Executive meetings as requested.
- Serves as organizational liaison for the quality Activities with Health Plan liaison.
- Maintaining Monthly Meeting with Health Plan Liaison.
- Responsible for creating company plans, standards and procedures to comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures.
- Responsible for creating company plans, standards and procedures to meet National Committee for Quality Assurance (NCQA) standards.
Quality Educator
Castellana, LLC
03.2013 - 03.2021
- Develop Workshops for PCP and office staff on the CMS 5-Star Program
- Provide individual education to PCP and Office Staff about the CMS 5 Star Program
- Visit primary physicians to perform HEDIS quality assessments and billing following policies established by CMS
- Train new employees in Castellana from any department regarding the HEDIS and 5-star program
- Develop and monitor corrective action plans for supplier that does not meet established quality metrics standards
- Participate and prepare presentation for PCP meetings, both rational and area.
Education
Master of Science - General Public Health
Medical Sciences Campus
University Of Puerto Rico05.2009
Bachelor of Science - Community Health Educator
Medical Sciences Campus
University Of Puerto Rico05.2001
Skills
- Knowledge and understanding of CMS regulation, HEDIS, STARS, CHAPS and HOS measures
- Ability to problem solve with consideration to all role-perspectives for well-rounded solutions
- Courage and creativity to think outside the box when appropriate
- Result Oriented
- Ability to work in team
- Time Management
- Strong computer skills
- Knowledge of Microsoft Word, Power Point, Excel
- Excellent verbal and written communication skills
- Bilingual
Certification
- HEDIS Measures 2022
Asociación de Facturadores Médicos de PR- August 2021
- Medical Billing
Coding ICD-10, CPT, Billing form Medical Office, Electronic Billing and Audit, Interamerican university of Puerto Rico - August 2021
Timeline
Mgr II Cx Engagement and Coordination of Care Unit
IPA Holdings, LLC
01.2023 - Current
Quality Special Project Specialist
Castellana Physician Services, LLC
03.2021 - 01.2023
Quality Educator
Castellana, LLC
03.2013 - 03.2021
Master of Science - General Public Health
Medical Sciences Campus
Bachelor of Science - Community Health Educator
Medical Sciences Campus
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