ROSALINA SURIEL DE JESÚS
UM Adm Coordinator II
Carolina,PR
Summary
Accomplished professional in healthcare administration with 8+ years of experience focused on operational leadership and provider relations. Skilled in enhancing processes, boosting team performance, and maintaining regulatory compliance. Effective communicator and data analyst, adept at fostering collaboration to support growth and quality in care delivery.
Overview
11
11
years of professional experience
5
5
Certifications
1
1
Language
Work History
Utilization Management Administration Coordinator II
Humana, Inc
10.2022 - Current
- Provide administrative and operational support to the Medical Management team, ensuring accuracy in appeals, denials, and returned mail processing.
- Handles inbound provider calls regarding authorizations and referral requests with accuracy and professionalism.
- Assist providers via the call center with authorization requests and case updates, maintaining compliance and service quality.
Lead Core Operations / Team Leader – HCS Core Programs
Molina Healthcare of Puerto Rico
01.2020 - 01.2022
- Supervised core operations related to claims, authorizations, and member correspondence within healthcare programs.
- Analyzed claims data to identify trends and recommend process improvements to senior management.
- Led a team of 10+ employees, enhancing performance metrics and accuracy in documentation by 20%.
Core Programs Lead Appeals and Grievance (Non-Clinical)
Molina Healthcare of Puerto Rico
01.2020 - 01.2020
- Managed workflows for approvals, denials, and member correspondence ensuring timely and compliant responses.
- Collaborated with compliance and clinical departments to improve service delivery and documentation accuracy.
Correspondence Processor
Molina Healthcare of Puerto Rico
01.2016 - 01.2020
- Processed and tracked member communications and authorizations with attention to detail and timeliness.
- Improved record-keeping systems to enhance efficiency and reduce retrieval time by 30%.
Administrative Assistant / Receptionist
Molina Healthcare of Puerto Rico
01.2015 - 01.2016
- Supported staff with administrative tasks, documentation, and customer service duties.
- Maintained accurate office records and managed communications effectively.
Education
Bachelor of Business Administration - Management, Minor in Psychology
Sacred Heart University
San Juan, PR01.2021
Public Administration Studies - undefined
MBTI Business Training Institute
San Juan, PR01.2002
Skills
Healthcare Operations Management Provider Relations Process Improvement Compliance & Quality Assurance Team Leadership & Training Project Coordination Reporting Member & Provider Communication Conflict Resolution
Certification
Leadership with Emotional Intelligence
Accomplishments
- Recognized for outstanding leadership and contribution to healthcare operations efficiency.
- Successfully reduced processing errors by 25% through workflow optimization initiatives.
- Implemented provider communication protocols that improved satisfaction rates and response times.
- Actively supported organizational compliance initiatives leading to enhanced audit readiness.
Timeline
Utilization Management Administration Coordinator II
Humana, Inc
10.2022 - Current
Lead Core Operations / Team Leader – HCS Core Programs
Molina Healthcare of Puerto Rico
01.2020 - 01.2022
Core Programs Lead Appeals and Grievance (Non-Clinical)
Molina Healthcare of Puerto Rico
01.2020 - 01.2020
Correspondence Processor
Molina Healthcare of Puerto Rico
01.2016 - 01.2020
Administrative Assistant / Receptionist
Molina Healthcare of Puerto Rico
01.2015 - 01.2016
Bachelor of Business Administration - Management, Minor in Psychology
Sacred Heart University
Public Administration Studies - undefined
MBTI Business Training Institute