Resume

Dona Weissenfels, BA, RHIT, CPHQ, CHC

ab0h8g@r.postjobfree.com – 602-***-****

Career Goal: Executive Leadership in a Healthcare Organization

Work Experience:

Sr. Manager, Customer Engagement & Quality, Blue Cross Blue Shield of Arizona

April 2013 – Present (4 months) Phoenix, Arizona Area

Assigned to Blue Cross Blue Shield of Arizona’s Health Insurance Exchange Federal product to develop Qualified Health Plan Subsidy Customer Service Division. Start-up of new unit includes hiring and training program development for the Customer Service Subsidy Unit. Training topics included Accountable Care Act, Health Literacy, HEDIS/CAHPS outreach and Arizona Community Resources. Responsible for development of Plain Language and Health Literacy training and materials company-wide. Acts as a liaison between Claims/Customer Service Division and the Health Services Division, responsible for the planning, development, implementation and evaluation of the healthcare consumer quality program with the Claims and Customer Service Division to ensure members have the proper information and engagement to achieve improved health outcomes.

Director of Quality: Blue Community Care, January 2013 – March 2013 (3 months) Phoenix, Arizona Area

Independent Contractor responsible for Medicaid Quality program development, RFP process for Acute Care Quality Management program development. Presented as part of the overall bid process RFP oral responses to The State of Arizona's Cost Containment System (AHCCCS) evaluation panel. Developed and wrote preliminary documents for start-up health plan; Quality Management and Maternity program description and work plans. Also wrote and submitted CMS Model of Care for dual eligible program. CMS awarded a three year opportunity to contract based on the Model of Care with CMS (D-SNP program). Medicaid and Medicare government quality program subject matter expert. Contract not awarded.

Director of Quality: SCAN Health Plan of Arizona, Phoenix, AZ: 2011 – 2013

Responsible for Quality Management performance of the Medicaid and Medicare contracts. Program oversight responsibility for HEDIS, CAHPS, HOS, Structure & Process, Model of Care, Pay for Quality, STAR ratings, performance improvement projects, credentialing and delegation oversight program activities.

• Supervise staff of ten quality performance and credentialing professionals.

• Improved overall Part C 2012 HEDIS ratings for Arizona market.

• Served on PSV vendor selection panel for Arizona Association Health Plans (AzAHP).

• Quality lead for Star Rating Improvement and physician incentive programs.

• Responsible for State of Arizona Long Term Care Contract for Quality.

• Oversight of D-SNP Quality program, Structure & Process and program compliance.

• Responsible for performance metric goals, Medicaid & Medicare.

• Transitioned Team from Medicaid only line of business work to Medicare Advantage.

Medicare, Quality Manager: CHC of Arizona, Medicare Advantage Health Plan, Phoenix, AZ: 2010 - 2011

Responsible for ensuring regulatory and compliance quality requirements for the Health Plan were met. Researched, planned, implemented and monitored project outcomes for CMS QIPs and CCIPs. Worked in-tandem with Population Health Management to produce MOC and D-SNP structure and process submissions. Served as quality improvement advisor on CHC cross-functional Star Improvement Teams (colorectal screening, osteoporosis in women who have had a fracture and diabetes screening).

• Directed quality improvement and compliance functions between CHC of Arizona, CIGNA Medical Group and contracted Provider Network.

• Provides consultation and direction to ensure programs and services are implemented at the highest standards and patients receive the highest level of care.

• Oversight responsibility for Model of Care (D-SNP) Administrative Team.

• Ensure that policies and procedures are monitored and updated to include regulatory changes.

Medicare Advantage, Quality Manager, Puget Sound Health Partners, Federal Way, WA: 2007 - 2010

Instrumental in the development and implementation of a start-up Medicare Advantage Health Plan (PSHP). Led various clinical, service and business activities to ensure operational efficiencies. Set vision; aligned goals with overall organizational plans. Responsible for establishing key business relationships with physician groups, Hospitals, State and County Department of Health, Senior Community Groups and other key Stakeholders.

• Provided direction and consultation to ensure key compliance issues were addressed with CMS and other regulatory agencies to protect business and ensure contract requirements.

• Responsible for contracting and monitoring performance of quality vendors; HOS, CAHPS, HEDIS data services and HEDIS abstracting services.

• Led PSHP to a Four Star Rating on CMS Report Card Part C & D.

• Successfully implemented quality improvement projects in a rapid business growth environment.

Medicaid Quality, HEDIS & Clinical Analysis Manager: Community Health Plan of Washington, Seattle, WA: 2002 - 2007

Responsible for building and restructuring Quality Management department and HEDIS survey program for directed quality improvement projects, clinical and service. Managed, trained and coached staff of six quality improvement coordinators. Ensured key compliance areas were addressed with State of Washington and other regulatory agencies to ensure contract compliance.

• Developed in-house HEDIS collection and abstraction program.

• Achieved 20% improvement in clinical rates for Asthma with targeted quality improvement project.

• Successful completion of yearly State required quality performance measures and contract expectations.

• Improved overall health plan Medicaid HEDIS rates to gain competitive advantage in the marketplace.

• Developed staff of clinical and service performance coordinators to successfully work with clinics, staff and other stakeholders. Designed and implemented successful projects with improved outcomes.

Project Manager/Liaison: Qualis Health (Pro-West), Seattle, Boise and Anchorage: 1997 - 2001

Accountable for ensuring successful communication and coordination between corporate and branch locations. Liaison with all offices to identify needs, align resources and champion staff. Self-directed project leader in Medicare and Medicaid quality improvement projects. Primary responsibilities include leading improvement initiatives directed by CMS.

• Partnered with State of Washington Diabetes and Cardiovascular Collaborative.

• Ensured project timelines, resources and personnel were in alignment with contract requirements and expectations.

• Provided extensive oversight of Idaho and Alaska contracts to ensure project management and improvement goals were met.

• Immunization Campaign Project Manager, Washington, Idaho & Alaska.

Education:

Loyola University of Chicago, Chicago, IL - Masters of Jurisprudence (MJ) - Anticipated graduation date May 2014

George Fox University, Newberg, OR - Bachelor of Arts Management of Human Resources (BA) - 1993

Portland Community College, Portland, OR - Associate of Applied Science Health Information Management (AAS) – 1990

Certifications:

Registered Health Information Technician (RHIT)

Certified in Healthcare Compliance (CHC)

Certified Professional in Healthcare Quality (CPHQ)