Yvette Diaz
Hampstead
Summary
Detail-oriented Provider Audit Analyst with a decade of experience ensuring regulatory compliance and ethical standards. Proven skills in Microsoft Excel and strategic decision-making, contributing to comprehensive audits that drive operational excellence.
Overview
26
26
years of professional experience
Work History
Provider Audit Analyst II
Horizon BCBSNJ/ Horizon NJ Health
Trenton NJ
08.2013 - 10.2023
- Conducted comprehensive audits to ensure compliance with regulatory standards and internal policies.
- Collaborated with cross-functional teams to develop and implement effective audit strategies and processes.
- Prepared detailed findings and recommendations for management review, aiding in strategic decision-making.
- Achieved timely completion of audit projects through effective planning, execution, and follow-up procedures.
- Prepared comprehensive reports detailing audit findings, recommendations, and action plans for management review.
- Supported external auditors during annual audits, providing requested documentation and addressing inquiries efficiently.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Prepared working papers, reports and supporting documentation for audit findings.
Research Analyst
Horizon BCBSNJ/ Horizon NJ Health
Trenton NJ
09.2001 - 08.2013
- Analyzed healthcare data to identify trends and inform decision-making processes.
- Interpreted data and made recommendations from findings.
- Analyzed large volume of data to identify patterns, trends and correlations.
- Increased customer satisfaction by analyzing feedback and implementing necessary changes.
- Generated reports detailing findings and recommendations.
- Evaluated customer needs and feedback to drive product and service improvements.
- Maintained overall safe work environment with employee training programs and enforcement of safety procedures.
- Educated staff on organizational mission and goals to help employees achieve success.
Provider Claim Resolution Specialist
Keystone Mercy Health Plan
Philadelphia, PA
03.1998 - 10.2001
- Resolved complex provider claims to ensure accurate reimbursement and compliance with regulatory standards.
- Analyzed claim discrepancies, collaborating with providers to facilitate timely resolutions and improve satisfaction.
- Implemented process improvements that enhanced accuracy in claims processing and reduced resolution timeframes.
- Monitored claim trends to identify areas for improvement and recommend strategic initiatives for operational efficiency.
- Enhanced claim resolution efficiency by streamlining the provider claim submission process.
- Continuously sought opportunities to enhance personal skills and knowledge relevant to the claims resolution field, contributing positively to job performance and career growth.
Education
GED -
Little Flower High School
Philadelphia, PA06-1989
Skills
- Microsoft Excel
- Coaching and mentoring
- Ethics and integrity
- Innovation and creativity
Timeline
Provider Audit Analyst II
Horizon BCBSNJ/ Horizon NJ Health
08.2013 - 10.2023
Research Analyst
Horizon BCBSNJ/ Horizon NJ Health
09.2001 - 08.2013
Provider Claim Resolution Specialist
Keystone Mercy Health Plan
03.1998 - 10.2001
GED -
Little Flower High School