Andrys Sanchez

A unique blend of clinical expertise and strategic management skills, specializing in optimizing healthcare operations and driving quality improvement initiatives. Led diverse teams, enhancing operational efficiency and ensuring compliance with stringent healthcare regulations. Integrated technology into clinical workflows to streamline processes and improve patient outcomes.

A recognized leader in the healthcare industry, actively contributing to legislative processes and regulatory discussions at both local and federal levels.

Physician Assistant (PA) at OFFICE OF DR FRANCISCO SANCHEZ PADILLA (2026-01 – Present)

• Obtain and document patient medical histories.
• Perform physical examinations under physician supervision.
• Measure and record patients' vital signs.
• Discuss patient cases with physicians and medical specialists.
• Prepare and maintain accurate medical documentation.
• Assist in patient evaluation, treatment planning, and follow-up care.

Utilization Department Director at MENNONITE HOSPITAL (2025-01 – 2026-12)

Same duties as Mennonite Medical Center, now including Stroke Unit Medical Utilization. APR-DRG committee director.

Utilization Department Director at GENERAL MENONITA HOSPITAL (2012-01 – 2025-12)

Supervised a team of 13 direct reports and managed the strategic direction of the Utilization Department across hospitals in Cayey (290 beds), Cidra, Aguas Buenas, and Comerío. Collaborated in committees, including Emergency Room, Utilization, Readmissions, Medical Faculty, Executive Committee, and a pilot program to transition the entity into a teaching hospital. Oversaw budget management, reduced overtime, minimized costs, and created a positive work atmosphere to promote maximum performance.

Interviewed, evaluated, and trained new leaders, contributing to leadership development and organizational growth. Implemented improvement plans that resulted in metric enhancements, including a net gain of $12M (target > $5M), reducing Length of Stay (LOS) to 5.25 days (industry average is 8), achieving denial rates of 4.9% (versus industry average of 12%), and reducing 15-day readmission rates to 5% (HP target > 12%). Collaborated with the Quality Department to develop strategic and tactical plans to reinforce regulatory compliance and improve service quality.

Implemented medication reconciliations for admitted patients to ensure adherence to treatment plans. Achieved outstanding results in external audits by developing the department's structure, including recruitment, policies, and procedures, and enhancing internal communication with other departments. Developed models adopted across the hospital conglomerate, including educational programs for physicians and other healthcare providers.

Managed regulatory matters with the Joint Commission, Federal and State Departments of Health, and CMS, ensuring compliance with new guidelines and regulations. Represented the hospital in the approval process for Law 5, testifying before the legislature and addressing extended hospital stays. Maintained 100% staff retention, fostering a diverse, resilient, and technology-embracing team across multiple generations.

Served as the hospital's representative in processes and initiatives with the Association of Hospitals. Provided consultancy to administrative leadership on contracting matters and other strategic decisions.

• Certified Interqual and Milliman clinical guidelines instructor, educating doctors on documentation, discharge criteria, and utilization performance.
• Managed complex medical appeals and multidisciplinary case reviews (cardiology, urology, surgery, ENT, neurology) and led peer-to-peer denials and care transition discussions.
• Directed treatment efficiency, appropriateness, and medical necessity evaluation on a case-by-case basis, ensuring optimal patient care and resource utilization.

Director Utilization Department at SAN LUCAS EPISCOPAL HOSPITAL (2010-01 – 2011-12)

Supervised a team of 8 direct reports in a 100-bed hospital and managed a $3M budget. Developed strategies to improve departmental metrics, including maintaining denial rates below 2%. Conducted meetings with coordinators, supervisors, case managers, and department links to review the status of all hospital patients and determine admission criteria, service intensity, severity of condition, and discharge criteria.

Participated in case discussions and managed appeals for denials. Served on the Medical Faculty Committee and other committees. Led discussions with health insurance auditors, internal hospital auditors, and medical staff to address and resolve case issues.

Drafted and managed appeal letters to health insurance, ensuring an accurate representation of patient cases to minimize denials. Developed remediation plans across hospital departments to reduce monthly denial rates, improving overall reimbursement. Structured the department by developing policies and procedures and supported the transition to electronic medical records.

Implemented a clinical documentation program with medical staff based on Interqual criteria, enhancing the accuracy and completeness of patient records. Collaborated with the coder coordinator to optimize reimbursement by discussing cases and ensuring proper documentation. Managed case management and discharge planning, working closely with the Social Work department to ensure appropriate patient care transitions.

Addressed cases of unpaid hospital services (e.g., MA10, medically needy). Identified and analyzed physician refusals, assessing the financial impact on the hospital.

Medical Auditor at UTICORP (2005-01 – 2010-12)

Served as a Case Manager and Clinical Auditor, handling over 35 cases per day. Visited hospitals, doctor offices, radiology centers, laboratories, and pharmacies to ensure accurate documentation and adherence to regulations. Conducted audits for quality control, reviewing medical records and claims using ICD10-CM, ICD4-CM, and CPT codes and ensuring compliance with legal and clinical terminology.

Audited HCC Quality Control, with experience in CMS regulations, Medicare Quality Programs, and Health Plans.

• Became the first auditor to conduct an audit using electronic medical records.
• Utilized coding systems for IPA assessments (HMO, PPO) in outpatient and general medicine, ensuring proper surgical utilization and coding procedures.
• Worked in the compliance department, verifying that no fraudulent claims were made to insurance companies and ensuring doctors' adherence to proper procedures.
• Conducted HEDIS audits and HCC coding verification, ensuring accuracy and compliance in claim submissions to insurance plans.
• Supervised HCC audits, verifying coding for claims sent to insurance plans and ensuring compliance with all relevant regulations.
• Participated in Joint Commission and Health Department of PR accreditation processes, contributing to hospital accreditation efforts.

Medicine Doctor in Medicine – Iberoamericana University Santo Domingo

Premedical Degree in Premedical – Interamerican University