Alex Vasquez

Dedicated bilingual Patient Access, Healthcare Operations, and Grievance & Appeals professional with 5+ years of experience supporting insurance verification, prior authorizations, specialty scheduling, claims processing, and member services in remote healthcare environments. Proven success managing high-volume workflows, maintaining HIPAA and CMS compliance, resolving complex member and provider issues, and delivering exceptional patient experiences through phone, email, chat, and virtual platforms. Skilled in EHR/CRM systems, documentation accuracy, care coordination, and cross-functional collaboration in fast-paced healthcare environments.

Analyst / Client Engagement Specialist - Jewish Board Children's and Family Services

(2025-12 - 2026-05)

Managed 60-120 high-volume inbound and outbound client communications while supporting outpatient behavioral health and CCBHC programs.

• Coordinated & scheduled 80+ daily appointments for therapy, medication management, clinical follow-ups, telehealth, and virtual care appointments while maintaining 98% accuracy and patient satisfaction.
• Resolved client concerns, de-escalated urgent situations, and ensured timely coordination with clinical teams.
• Maintained 98% accurate documentation within the Avatar (myAvatar) EHR system while ensuring HIPAA compliance.

Correspondence Associate III (Contract) - Centene Corporation - Remote

(2025-10 - 2025-11)

• Generated and processed 70-80+ daily regulatory approval and denial correspondence while meeting strict turnaround standards.
• Maintained documentation accuracy and compliance within a fast-paced remote healthcare environment.

Medical Specialty Scheduler - UnitedHealthcare / Optum - Remote

(2024-11 - 2025-06)

Scheduled 70-100+ specialty (Anticoagulation, Audiology, Ear, Nose & Throat (ENT), Endocrinology, Foot & Ankle, Infusion, Integrative Pain Management, Neurology, Orthopedics, OB/GYN, Rheumatology, Sports medicine) & Primary care appointments daily while verifying insurance eligibility, referrals, and authorizations.

• Provided bilingual support for patients and providers, resolving scheduling and care coordination issues.
• Maintained patient records in EPIC, Citrix, and Harmony systems ensuring documentation accuracy.

Grievance & Appeals Intake Coordinator - Molina Healthcare - Remote

(2024-01 - 2024-08)

Temporary Contract Remote position.

• Reviewed 50+ daily incoming grievances and appeals to determine case validity in accordance with regulatory guidelines.
• Generated 60+ daily acknowledgment, denial, and approval letters while consistently meeting SLA and TAT requirements.
• Coordinated documentation collection and case tracking to support compliance and audit readiness.

Grievance & Appeals Specialist - Elevance Health (formerly Anthem) - Remote

(2021-12 - 2024-01)

Managed end-to-end grievance and appeals workflows for members and providers while ensuring regulatory compliance across Commercial, Medicaid, and Medicare Dual Enrollment plans.

• Processed medical claims and resolved complex discrepancies using ICD-10, CPT, and HCPCS codes.
• Reviewed and resolved a high-volume caseload of member and provider grievances and appeals while maintaining documentation accuracy, regulatory compliance, and required TAT performance.
• Maintained a 97% monthly quality assurance score while handling high-priority escalations and correspondence.
• Investigated complex member and provider disputes while ensuring compliance with CMS, state, and organizational guidelines.

Tier 2 Unemployment Insurance Adjudication Supervisor - Solid State Operations (Aerotek Contract) - Remote

(2021-01 - 2021-09)

Directed day-to-day work operations for a team of 25+ staff, ensuring strict alignment with daily operational targets and driving a 35% improvement in team performance.

• Managed escalations, workflow compliance, and bilingual customer support while meeting operational KPIs.

Customer Experience Manager - WK Travel - Las Vegas, NV

(2020 - 2021)

Admissions Lead Call Center Representative / QA - Stanbridge University - Irvine, CA

(2018 - 2020)

Call Center Lead Representative - AltaMed Health - Santa Ana, CA

(2015 - 2018)

Associate of Applied Science (A.A.S.) - Health Information Technology - College of Southern Nevada (CSN) (2028-05)

General Equivalency Diploma (GED) - Long Beach Job Corps Center (2005)