... Record systems in capturing healthcare outcomes data $ Expertise in regulatory agency interface, including JCAHO, OSHA, NCQA/HEDIS
, HCFA, HIPAA (Privacy Rules and Regulations, Administrative Simplification and Coding), ICD $ Experience in complex ...
- Sep 15
... Roughly $6M paid out to PCPs during my tenure, resulting in 30% improvement in HEDIS
scores, GDR usage up 20%, ER usage down 8%, 10% reduction in LOS - in the first year of the P4P. . Participated with management in the development of the Plan's ...
- Sep 08
San Jose, CA
... design, development and testing of various healthcare softwares namely MVS, MSR, and HEDIS
healthcare softwares right from its inception using VB.NET, ASP.NET 2.0, SQL Server 2000/2005, VBA, Crystal Reports, Business Objects, SSIS and SSRS. ...
- Sep 07
... Clinical Operations Microsoft Office ACT Project Management CRM Easy Dental Quality improvement/assurance NCQA/HEDIS
Practice Works HIPAA Compliance OSHA Compliance EagleSoft Medicare/Medicaid EMR Provider Relations Contract negotiations ...
- Sep 04
... modification * HEDIS
/MRA EMR retrieval procedures, case/records management, medical terminology * Proven ability to work effectively with third party administrators, workforce, human resources, pre-employment, union and operational management. ...
- Sep 03
... and risk groups • Successfully facilitate/implement various initiatives with groups (HEDIS
, MRA, STARS, etc.) MGK Insurance, Senior VP Of Benefits 2013- 2009 • Successfully positioned company as a competent leader in the small group employer arena. ...
- Sep 03
... • Medicare Risk Adjustment (MRA) • Comprehensive Primary Care Initiative (CPCI) • Healthcare Effectiveness Data and Information Set (HEDIS
) • Centers for Medicare and Medicaid Services (CMS) • Proficient in Excel, Word, Access, CAS, EMPI, PAAG, CGX
- Sep 01
... member’s medical records for Risk Adjustment Data Validation audit Contacted provider offices in an assigned territory to schedule medical record reviews for HEDIS
(Healthcare Effectiveness Data and Information Set) and PIA (Payment Integrity Audit). ...
- Aug 31
Thousand Oaks, CA
... Gather technical requirements from multiple teams and departments to coordinate reporting efforts Pull data from multiple sources (TSI, Eclypsis, HEDIS
, and Financial databases), transform and input data into SAS based Balanced Scorecard system. ...
- Aug 31
Forest Park, GA
... and software programs quickly EMPLOYMENT HUMANA Atlanta, GA April 2012 – Present Specialist •Organize/conduct chart audits with physicians and/or office administrators for the purpose of completing HEDIS
, MRA, and MCCI accreditation standards. ...
- Aug 19
... 02/2013- 05/2013 Cigna Insurance HEDIS
Administrative Assistant Contact health care professionals to request the medical records of patient’s that were seen in their office during 2012, and abstract the necessary information needed to comply with ...
- Aug 19
... membership and claims data from WellPoint Health Networks with BlueChoice HealthPlan’s provider network in preparation for HEDIS
audits Developed complex statistical reports, charts, pivot tables and spreadsheets identifying trends in HEDIS
- Aug 19
... • Developed a Medical Records Review Administrative Database application for the Quality Improvement department to collect medical record review data for HEDIS
/QARR and MEDS each reporting year. The database is created according to NCQA requirements ...
- Aug 15
... 2012-Feb 2013 HEDIS
, Field Chart Reviewer Simply Healthcare Plans June 2010-August 2012 Field Case Manager in Broward and Dade Counties Hospitals, Coded Diagnosis and Procedure (ICD-9, CPT) Reviewed Charts in Broward and Dade Counties PCP's and ...
- Aug 13
... • Excellent communication skills/Strong team player • Supervisory/Training experience • Cash handling and customer service experience • HEDIS
Stars and Wellcare visits WORK EXPERIENCE AWARDS: MILITARY EXPERIENCE: Chappel Family Practice May2014 ...
- Aug 11
... Employment 2014- 2014 HEDIS
Medical Record Review Cigna Insurance Company. 500 Southborough Drive #302 South Portland, Maine 04106. HEDIS
Medical Record Review. 2006-2013 - ******* Legal Nurse Consulting. 1 Noonan Drive, Londonderry, New Hampshire ...
- Aug 03
... Knowledge of HEDIS
Measures, NCQA compliance on Quality Assurance in patient care, HIPAA and PHI. Experience working with EHR systems. Detail oriented with great customer and client service skills. Team oriented with the ability to multitask and ...
- Jul 31
... I am also trained in medical billing, HEDIS
measures, CPT & CPT II codes (F codes), ICD 9 codes, and Encounter codes. I have over thirty clinical offices running the EHR software on M3 mode, that’s on meaning full use; most of them are waiting for ...
- Jul 30
... *-*** Methuen, MA 01844 (978) ***-**** Experience Nurse Reviewer 11/2012 - 10/17/2013 Medix Staffing Solutions, HMS Permidion, Charlestown, MA Temporary contract Utilization Review - see nurse reviewer details below for responsibilities HEDIS
- Jul 29
... Jan Rowe RN **** ********* ***** ************, ** 32256 904-***-**** email@example.com Cardiac Triage RN Experience Florida Blue RN HEDIS
project February 2014--May 2014 RN telephonic Case Management and Data Collection Working closely with ...
- Jul 22