Martha Jeannette Alicea Ruiz
Bayamón
Summary
Dynamic leader with extensive experience at Medical Card System, excelling in project management and operational execution. Proven track record in enhancing compliance and driving quality assurance initiatives. Skilled in strategic planning and team leadership, effectively delivering educational programs that elevate provider performance and improve health outcomes.
Overview
20
20
years of professional experience
Work History
IPA Management Operations & Home Program Director
Medical Card System
06.2019 - Current
- Lead the operation of clinical projects assigned to IPA Management
- Monitor the compliance of goals established in the Elderly Home Program and IPA workplan
- Effectively supervise IPA Management Operations and Elderly Home Program teams
- Lead MCS STARS Ratings and MOC Initiatives for Provider Operations
IPA Management Manager
Medical Card System
05.2015 - 06.2019
- Manage projects assigned to IPA Management
- Monitor compliance of the goals established in the IPA work plan
- Provide monitoring documentation to IPAs and offered recommendations for improvement
- Effectively supervise IPA account executive team
Premium Management Education Specialist
Medical Card System
02.2010 - 05.2015
- Develop, coordinate and provide educations to physician groups/offices on correct coding initiatives, good documentation practices, Risk Adjustment model and HEDIS measures that impact STARS
Medical Policy Research Specialist
Medical Card System
06.2008 - 02.2010
- Research and identify best practices and evidence-based studies of new technology, drugs and clinical topics
- Prepare analysis and recommendations based on findings
- Utilize knowledge in ICD-9 and CPT coding for appropriate policy identification
- Develop classroom trainings to staff on approved medical policies criteria
Provider Outreach & Education Specialist
Triple S Medicare
08.2005 - 06.2008
- Analyze inquiry data to set priorities for educational efforts
- Develop instructional materials for seminars, workshops and teleconferences
- Conduct educational activities on a constant basis to ensure the dissemination of updated information to Medicare providers (Puerto Rico and Virgin Islands) and staff
Education
Project Management & Agile Professional Course -
Agil Ratio Institute
04.2023
M.Ed. - Training and Organizational Development
Cambridge College
08.2008
Medical Coding Training (CPC) -
American Academy of Professional Coders
11.2007
Pharmaceutical Representative Training -
Quality Reps of PR
07.2002
B.S. - Biology, Medical Technology, Medical Sales
University of Puerto Rico
05.2002
Skills
- Project management
- CMS Technical Specifications
- Operational deliverables execution
- Action plan development
- Progress updates
- Microsoft Office
- MCS applications
- Communication
- Leadership
- Team Management
- Conflict resolution
- Strategic planning
- Budget management
- Organizational leadership
- Risk Management
- Data analysis
- Process improvement
- Quality assurance
- Regulatory compliance
- Team leadership
- Policy and procedure improvements
- Training coordination
- Effective communication
- Program strategy development
- KPI tracking
Languages
Spanish
First Language
English
Advanced (C1)
C1
References
References available upon request.
Timeline
IPA Management Operations & Home Program Director
Medical Card System
06.2019 - Current
IPA Management Manager
Medical Card System
05.2015 - 06.2019
Premium Management Education Specialist
Medical Card System
02.2010 - 05.2015
Medical Policy Research Specialist
Medical Card System
06.2008 - 02.2010
Provider Outreach & Education Specialist
Triple S Medicare
08.2005 - 06.2008
Project Management & Agile Professional Course -
Agil Ratio Institute
M.Ed. - Training and Organizational Development
Cambridge College
Medical Coding Training (CPC) -
American Academy of Professional Coders
Pharmaceutical Representative Training -
Quality Reps of PR
B.S. - Biology, Medical Technology, Medical Sales
University of Puerto Rico