Angelica Mora

Healthcare operations professional with experience in RADV medical record retrieval, provider outreach, and CMS-compliant documentation. Proven ability to manage high-volume workloads, navigate EMR and portal-based systems, and support risk adjustment audits through accurate, audit-ready processes.

Background in health insurance, Medicare, and customer-facing healthcare operations.

Optum Outreach operations specialist at Unitedhealth group (2025-06 – Present)

• Conduct outbound and inbound provider outreach to obtain medical records for Risk Adjustment Data Validation (RADV) audits in compliance with CMS requirements
• Coordinate medical record retrieval through multiple collection methods including fax, provider portals, EMR systems, mail, and third-party copy services
• Verify provider and facility information using NPI registry, practice websites, and internal databases to ensure accurate routing of chart request
• Manage high-volume workloads while consistently meeting productivity and quality benchmarks, including daily call quotas, release targets, and activity metrics
• Document all outreach attempts and provider responses using audit-ready, HIPAA-compliant notes

Health Benefits Coordinator at Delta Dental Insurance (2022-03 – 2023)

• Educated members on health and dental benefit options, supporting informed decision-making during enrollment periods
• Responded to inquiries regarding eligibility, coverage, and plan options
• Maintained accurate documentation of member interactions to ensure compliance and follow-up

Assurance IQ Medicare Sales Agent at Qualfon Call Center (2019-05 – 2021)

• Advised beneficiaries on Medicare plan options in accordance with CMS guidelines and regulations
• Completed enrollment documentation with accuracy and attention to compliance requirements
• Conducted needs-based consultations to match members with

Dispatch Security Supervisor at Allied Universal Security Services (2020-05 – 2022)

• Supervised dispatch operations and coordinated daily staffing schedules
• Prepared incident and activity reports related to property security and safety
• Collaborated with law enforcement and site leadership to reduce theft and safety risks

Associates degree in Liberal Arts – Southern New Hampshire University (2026-03)