Rafael Sosa
About Rafael Sosa
Rafael Sosa serves as the Electronic Data Interchange (EDI) Manager at EmblemHealth, where he has worked since 2014. He has extensive experience in regulatory compliance and has previously held positions at CSC and Insignia Financial Group.
Work at EmblemHealth
Rafael Sosa has served as the Electronic Data Interchange (EDI) Manager at EmblemHealth since 2014. In this role, he provides leadership and expertise in regulatory compliance, focusing on HIPAA, HITECH, and the False Claims Act (FCA). His responsibilities include overseeing the development and implementation of EDI processes, ensuring that the organization meets all necessary compliance standards. Sosa has also contributed as a Subject Matter Expert in various projects, including the All-Payer Database (APD).
Previous Experience in Healthcare Compliance
Before joining EmblemHealth, Rafael Sosa worked at CSC as a HIPAA Compliance Manager from 2003 to 2014. In this position, he was responsible for ensuring that the organization adhered to HIPAA regulations. His experience in compliance management spans over a decade, during which he created essential HIPAA policies and procedures for multiple organizations across the United States.
Career Background in Technology and Management
Rafael Sosa's career began in the technology sector, where he worked as a System Analyst at BMW of North America, LLC from 1984 to 1991. He later transitioned to the financial services industry, serving as a Manager at Insignia Financial Group, Inc from 1991 to 1996. His diverse background in technology and management has equipped him with a unique skill set applicable to his current role in healthcare compliance and data interchange.
Education and Training
Rafael Sosa has pursued education in various institutions, including Passaic County Community College and Hudson Valley Community College, where he studied Management. He also attended the Electronic Computer Programming Institute, gaining foundational knowledge in programming. This educational background supports his expertise in electronic data interchange and compliance management.
Achievements in Cost Savings and Database Development
Rafael Sosa analyzed the New York State Medicaid system, identifying potential savings of $2 million per week for the program. Additionally, he led the development and implementation of the All-Payer Database (APD) as an EDI Subject Matter Expert. His contributions have had a significant impact on the efficiency and effectiveness of data management within the healthcare sector.