Yvette Aguilar
@yvetteaguilar
Risk and quality leader improving HEDIS/HCC performance through data-driven operations, training, and claims accuracy.
ZimbabweWhat I'm looking for
I’m a Risk/Quality Supervisor with 14+ years leading operations that strengthen quality outcomes and compliance. At UHG/Optum, I developed standardized work processes, hired and led a department of 23 risk/quality clinic coordinators, and delivered staff training that improved competency, compliance, and health plan performance.
I drive measurable results by analyzing Risk and RAF scores data, optimizing workflows, and improving quality metrics—raising star metrics within 90 days from 1.3 to 4.8. Previously, as an Operations Manager, I managed operations for five medical practices, coordinated audits, supported HIM/TOC processes, reduced denials by correcting coding errors, and earned innovation and leadership awards while collaborating across Population Health, Finance, RA, and IT. I’m currently enrolled in AAPC to obtain certification.
Experience
Work history, roles, and key accomplishments
Risk/Quality Supervisor
UHG / Optum
Oct 2022 - Present (3 years 6 months)
Developed standardized work processes to support consistent quality outcomes for a newly formed risk/quality department, leading HR functions and a team of 23 clinic coordinators across the IE region. Improved quality metrics, including Star metrics increasing from 1.3 to 4.8 within 90 days, reduced denials by correcting coding errors prior to submission, and advanced RAF/HCC capture through AWV,
Operations Manager
KMSM IE
Nov 2008 - Sep 2022 (13 years 10 months)
Managed operations for five medical practices, overseeing credentialing, contracting, HR, and administrative needs while driving risk and quality performance across 5-Star, HEDIS, and HCC measures to increase revenue and reduce risk/cost. Coordinated insurance audits to maintain site compliance, managed provider on-call schedules and credentialing, and supported end-to-end patient admin workflows
Education
Degrees, certifications, and relevant coursework
AAPC
Professional certification, Medical coding / Health information management
Currently enrolled in AAPC to obtain a certification.
Availability
Location
ZimbabweAuthorized to work in
Job categories
Skills
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