Raul A. Rodriguez Hernandez

WORK HISTORY

EDUCATION

ABOUT RAUL A. RODRIGUEZ HERNANDEZ

I’m a dedicated healthcare compliance professional with over 10 years of experience supporting Medicare and Medicaid programs. My work has given me the opportunity to develop strong skills across Appeals & Grievances, Auditing, Delegation Oversight, and Revenue Integrity. Over the years, I’ve learned the importance of doing things correctly, staying consistent, and making decisions based on data, transparency, and integrity.I’ve supported CMS, DOI, URAC, and NCQA audits; implemented Corrective Action Plans (CAPs); and contributed to process improvements that strengthened compliance operations. Whether I’m reviewing cases, analyzing trends, supporting a team, or partnering with other departments, my focus is always the same: protect the organization, support members, and maintain compliance with honesty and clarity.I don’t try to be perfect, I simply care about doing the right thing. I believe in staying grounded, listening first, and learning something new every day. Compliance is constantly evolving, and I enjoy adapting, collaborating with others, and helping teams understand and apply regulatory expectations in a practical way.I’m passionate about building workflows that make sense, improving accuracy, reducing errors, and creating a culture where compliance isn’t just a requirement, but a shared responsibility. I enjoy helping others grow, sharing knowledge, and contributing to solutions that make the work easier and more efficient for everyone.At the end of the day, my goal is to bring value, serve with integrity, and support an environment where members, providers, and teams can depend on reliable and compliant processes. I am bilingual in English and Spanish and committed to continuous improvement, both personally and professionally.