Chandrae J. Pryor

**** ****** ****, ******, ** **082 404-***-**** aca50w@r.postjobfree.com

PROFESSIONAL SUMMARY

Results driven, with a proven track record. Extensive experience in Core

Measure data abstraction, medical billing and coding, quality

management/utilization/concurrent review. Medicaid/Medicare. Effective

problem solving, analytic and communication skills. Demonstrates

adaptability to changes in business needs by effectively managing case

loads to include HEDIS, appeals, quality of care, medical record reviews,

etc. Developed training material used to train colleagues on new/updated

processes. Serves as a technical resource in mentoring staff. Improved

HEDIS performance rates continuously over a three year period.

Performance Champion Award - Amerigroup 2010.

PROFESSIONAL EXPERIENCE

Amerigroup Community Care, Atlanta, GA

3/2011- Present

Manager, Quality Management

Gap analysis and education, outreach provided to physicians on

billing codes and improved quality measure performance.

Manage the retrieval, collection and abstraction of medical

records to support NCQA, state, and federal requirements

Drive quality improvement initiatives for quality management

program activities

Reporting of the Health Effectiveness and Data Information

Sets (HEDIS) data via verbal and written presentations

Interviews, trains, manages, evaluates, and develops new and

existing clinical/non clinical staff

Conducts, as appropriate, oversight audits/over-reads for

delegated vendors and internal staff.

Amerigroup Community Care, Atlanta, GA

12/09-3/2011

HEDIS Project Coordinator

Manage the HEDIS project life cycle including the validation review

process, weekly reports, export/import data, coordination and assignment

of project plans, manage resources and facilitate project execution,

deployment and closure.

Assists in defining opportunities for improvement identified through

analysis of trends and communicates these appropriately.

Conducts, as appropriate, oversight audits for Delegated vendors.

Managed performing and collecting data and medical record activities to

support NCQA, state and federal requirements

Manages and updates database tracking systems

Supervision of Temporary employees.

Amerigroup Community Care, Atlanta, GA 12/2006 - 3/2011

Quality Operations Nurse

Process appeals and updating request for services.

Concurrent Review/UM-Prior Authorization

Investigate quality of care issues/Grievances.

Summarize and prepare credentialing files.

Onsite review of medical records at provider offices to meet state

requirements.

Perform medical record/chart review, abstraction for HEDIS measures for

NCQA accreditation.

Peach State Health Plan, Atlanta, GA 1/2006 - 12/2006

Concurrent Review Nurse

Manage inpatient admissions through concurrent review via fax, email,

telephonic, and onsite.

NICU- concurrent review using Milliman Care Guidelines

Process authorization for requested inpatient/outpatient services using

Interqual and Milliman Care Guidelines.

Assist with discharge planning. Monitor quality of care and ensuring an

appropriate level of care is being rendered in the most cost effective

way.

Medical record review/data abstractions onsite at provider offices,

hospitals, and health departments.

Central Home Health of Amedisys, Atlanta, GA 7/2005 - 4/2008

Home Health Nurse / Case Manager

Provided Nursing Services throughout Atlanta; Calling and Verifying MD

orders; monitoring lab work; monitoring patient appointments; Care review

meetings. Scheduling of patient visits to ancillary staff.

Brighton Gardens Of Vinings, Atlanta, Georgia

6/2004 - 7/2005

Health Care Coordinator/Manager

Provided overall leadership and management of the health and well being of

the residents within the community.

Quality assurance, regulatory compliance, coordination of resident's

health and wellness needs, medication program management and resident

assessments, Individual Service Plans (ISPs) and ancillary health

services.

Managed overseeing the medication programs.

Recruiting, hiring and training of clinical team members.

Completing clinical staffing.

Led team member leadership including engagement, performance management

and evaluations.

Grace Manor HCF, Buffalo, NY

5/2001 - 2/2004

Resident Care Coordinator/Manager

Managed resident care on the unit.

Ensures required patient assessments and interventions are completed.

Assists the physician in therapeutic measures, as needed.

Participated in care plan development and attends resident care

conferences for the unit.

Helps determine policies for improvement of care.

Reviews physician's orders to ensure they are appropriately recorded.

Conducts weekly shift meetings with nursing assistants.

Participated in the Performance Improvement Process.

Participated in the Interdisciplinary Plan of Care ("IPOC") process for

assigned residents.

Grace Manor HCF, Buffalo NY

12/1999 - 5/2001

Clinical Instructor

Mastery over the theoretical concepts and the practical procedures

involved in overall patient care.

Planned and conducted orientation and training program for

professional/nonprofessional personnel to include explanations of

policies, employee benefits and organizational structure for new hires.

Organized and updated nursing procedure manuals and guides for use by

nursing personnel.

Scheduled classes, provide in-service to nursing/non nursing personnel

Assisted nursing service supervisory personnel in solving care related

issues.

Grace Manor Health Care Facility, Buffalo, NY

5/1998 - 11/1999

LPN staff nurse

Episcopal Church Home, Buffalo, NY

7/1996 - 5/1998

LPN staff nurse

Manor Oak SNF, Cheektowaga NY

10/1992 - 7/1996

Certified nursing assistant

EDUCATION AND PROFESSIONAL DEVELOPMENT

Medical Coding and Billing Specialist US Career Institute 2005

L.P.N Buffalo Vocational Technical Center Buffalo, NY 3/1996

HONORS AND AWARDS

Performance Champion Award - Amerigroup Corp 2010

Georgia LPN

New York LPN

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