Carmelita Madriles
San Diego,CA
Summary
Healthcare data professional with a strong background in data extraction, integration, and reporting. Proficient in analyzing patient population health data and generating automated reports. Skilled in designing efficient data systems to improve healthcare reporting. Experienced in ensuring data quality and collaborating with IT teams to implement effective healthcare reporting systems.
Overview
21
21
years of professional experience
Work History
Data Quality Supervisor
San Ysidro Health
11.2014 - Current
- Led quality improvement initiatives to enhance service delivery and patient outcomes
- Oversaw quality assurance processes, including the Ryan White Services Report (RSR) using client-level data
- Developed, validated, and analyzed program reports using NextGen Electronic Health Record, Epic Electronic Health Record, AIDS Regional Information and Evaluation System (ARIES), i2i Population Health System, and SQL Server Reporting Services (SSRS)
- Collaborated with Information Technology to design and implement data-driven reports for program evaluation
- Collaborated with Human Immunodeficiency Virus (HIV) management, clinical leadership, and research teams to collect and analyze statistical data on vulnerable populations, including People Living with HIV (PLWH), People of Color (POC), individuals with Substance Use Disorders (SUD), Men Who Have Sex with Men (MSM), and the LGBTQIA+ community
- Conducted client satisfaction surveys and facilitated HIV Clinical Team meetings to drive service improvements
- Served on the Electronic Health Record Change Advisory Board and HIV Department Quality Committee
- Provided training for San Diego State University interns and led staff development initiatives
- Reviewed electronic health record documentation for accuracy and completeness
- Managed data cleaning, tracking, and SQL-based patient population health reporting
- Monitored adherence to healthcare guidelines and HIV performance metrics
- Ensured compliance with Uniform Data System (UDS) Enabling Services and Sexually Transmitted Infections (STI) data reporting requirements
Reimbursement Specialist II
San Ysidro Health
11.2007 - 11.2014
- Managed medical insurance billing for ten clinics, covering County Medical Services, Low-Income Health Program, Ryan White Care Act, California Healthy Families Programs, and State of California HMO plans
- Oversaw billing operations, including claims submission, eligibility verification, and accounts receivable tracking for multiple programs
- Audited and reviewed insurance claims, identifying discrepancies and initiating disputes to maximize reimbursement
Patient Services Coordinator
Healthcare Management Partners
03.2004 - 10.2007
- Verified insurance coverage, processed billing claims, and managed account appeals for various insurance providers
- Specialized in Medicare, Medi-Cal, PPO, HMO, and POS insurance plans, ensuring accurate claims processing and reimbursement
Education
Bachelor of Science - Information Technology – Database Management
Capella University
Introduction to SQL - undefined
Southwestern College
Patient-Centered Medical Home (PCMH) Course - undefined
San Ysidro Health
Lean Six Sigma (100-Hour Course) - undefined
San Ysidro Health
Medical Procedural Coding Certificate - undefined
University of California San Diego Extension
Skills
- Data Extraction, Integration & Reporting
- Healthcare Data Analysis & Visualization
- Performance Metrics & Quality Reporting
- Data System Report Design & Development
- Healthcare Data Reporting & Development
- Data-Driven Insights & Decision Support
Timeline
Data Quality Supervisor
San Ysidro Health
11.2014 - Current
Reimbursement Specialist II
San Ysidro Health
11.2007 - 11.2014
Patient Services Coordinator
Healthcare Management Partners
03.2004 - 10.2007
Introduction to SQL - undefined
Southwestern College
Patient-Centered Medical Home (PCMH) Course - undefined
San Ysidro Health
Lean Six Sigma (100-Hour Course) - undefined
San Ysidro Health
Medical Procedural Coding Certificate - undefined
University of California San Diego Extension
Bachelor of Science - Information Technology – Database Management
Capella University
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