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Skills

  • Relationship development
  • Collaboration with healthcare providers
  • Cross-team collaboration for HEDIS projects
  • Best practice implementation for record reviews
  • Business operations
  • Recordkeeping
  • Effective communication with medical offices
  • Continuous improvement in HEDIS score reporting
  • Budgets
  • Chart review for HEDIS compliance

Work Experiences

  • Analyzed chart abstraction data from 16+ medical centers, uncovering trends and improving HEDIS scoring accuracy by 55%.
  • Achieved a 85% improvement.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Data from participant interviews was coded.
  • Assisted in the development and refinement of HEDIS abstraction protocols, leading to a 52% improvement in protocol adherence rates across Atlanta teams.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved over 85% compliance for report submission deadlines.
  • Assessed cancer screenings.
  • Clarified discrepancies in records.
  • Had an excellent attendance record and was always on time for work.

Summaries

  • Achieved exceptional compliance results.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved 32% faster record retrieval.
  • Adaptable HEDIS Field Reviewer recognized for training and mentoring junior reviewers, reducing team-wide data errors by 49% and accelerating chart review turnaround times.
  • 10 years' experience in medical record auditing.
  • Motivated individual who has spent more than 18 years working for a Brightline organization and has been trained to be a top-level Interviewer.
  • Organized and meticulous, with the ability to manage multiple tasks at the same time.
  • Within Miscellaneous, senior HEDIS Field Reviewer and outstanding performer in stakeholder engagement and workflow optimization.
  • Contributed to 28% improvements in audit readiness.
  • 9 years of field experience.

Accomplishments

  • Performed quality assurance on data abstracted from patient charts, ensuring a compliance rate of 58% with HEDIS regulations while reducing errors.
  • Managed and ensured timely submission of medical documentation data from 4 providers, maintaining an above 21% compliance rate throughout the audit process.
  • Collaborated with team of 16 in the development of standard.
  • Streamlined medical documentation retrieval timelines, reducing data retrieval time by 23% and helping the audit team meet critical deadlines.
  • Performed complex chart abstractions across 17 patient records, identifying key areas of improvement for compliance with 65% HEDIS measures.
  • Created a comprehensive quality assurance protocol that improved medical record retrieval accuracy by 40%, reflecting in a smoother audit process.
  • Improved communication with medical office staff to clarify HEDIS documentation requirements, which raised submission accuracy by 67% in Austin.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Utilized Power BI to automate HEDIS measure tracking, increasing reporting efficiency by 46% compared to previous audit cycles.
  • Resolved product issue through consumer testing.

Affiliations

  • Society of Human Resource Management
  • Toastmasters
  • Jaycees
  • National Association for Healthcare Quality (NAHQ)
  • Professional Association of Health Care Office Management (PAHCOM)
  • Medicare and Medicaid Services Regulatory Compliance Forum
  • Association for Computing Machinery
  • Association for Professionals in Infection Control and Epidemiology (APIC)
  • American Association of Managed Care Nurses (AAMCN)
  • Academy of Managed Care Pharmacy (AMCP)

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Certified in Health Information Technology (CHIT) by Cedar Works
  • ServSafe
  • Certified Managed Care Professional (CMCP) by Lakeside Partners
  • SHRM Certified Professional (SHRM-CP)
  • Certified Professional in Health Quality (CPHQ) by NAHQ
  • Certified HEDIS Compliance Auditor (CHCA) by Lakeside Partners
  • Certified Risk Adjustment Coder (CRC) by AAPC
  • Healthcare Auditor (HC) Certification by Beacon Labs
  • Google Certified Professional Cloud Architect

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