Medical Billing
Resume:
Rita Hatfield
Dundalk, MD 21222
*******@*****.***
Professional Summary
I have worked in HEDIS for over 10 years. I am versed in understanding Value Based Purchasing Measures. Seeking a position to develop and implement new and innovative health care improvement processes and admission procedures. I am also back in school for my Medical Billing Coding degree.
Core Qualifications
●Staffing management capability
●Proficient HIPPA compliances in Value Based
Purchasing Measures
●Organizational and time management skills
●Personal and professional integrity
●Effectively influences others
●Staff training and development
●Sound decision making
●Relationship and team building
●Problem resolution ability
●Cultural awareness and sensitivity
●Team player with positive attitude
●Exercises good judgment
●Excellent customer service skills
●Patient-oriented
Experience
HEDIS SERVICE ASSOCIATE II-MEDICAL QUALITY-WEST-JULY 17, 2017 TO PRESENT
POPULUS GROUP
●Pilot program, outreaching members and assisting them with scheduling appointments for their HEDIS Measures
●.Pilot program, outreaching providers and faxing over care coronation letters to ensure HEDIS Measures are met.
●Year round medical record review, with acquiring and splitting charts.
●Medical Record review was responsible for a 5,000 member fax blast, and maintained spreadsheet accuracy for weekly reports
HEDIS SUPERVISOR-June 2009 to July 21, 2017
MARYLAND PHYSICIANS CARE
●Proficient in knowledge of all guidelines in HEDIS measures to insure quality management with the Medical Record Review and HEDIS outreach department.
●Insure all NCQA regulations are met, as well as all HIPPA guidelines..
●Good understanding of CPT9 & CPT10 Codes regarding HEDIS measures.
●Excellent public speaking and presentation abilities. Able to develop strong rapport quickly.
●Supervise 10 staff members, consisting of 5 Quality Nurses and 5 Outreach staff.
●Perform Quality Checks on procedures in the department to insure all HIPPA and NCQA regulations are followed and kept.
●Created productivity program and held monthly 1:1 meetings with staff.
●Successfully designed new organizational systems for increase productivity.
●Monitor calls daily with the Avaya Phone system with CMS Supervisor.
●Complete mid-year and end of the year reviews.
●Work on completing desktops for procedures in the department.
●Updated and create power point training for new employees, to include all measures staff and strategies when outreaching members. .
●Work with OMNI regarding gift cards, with being responsible for uploading $25,000 to $35,000 in gift cards a month, as well as being 100% accountable for gift cards in-house and for clinics.
●Worked Medical Record Review for over 10 years, to include data entry of all abstractions using QSHR, keeping weekly reports and matrix on records received from nurses, assigning to Over-Readers, and filing as well as being able to handle any other assignments asked to be completed for the annual Medical record Review.
●Worked on Year Round Medical Record Review, faxing providers for records, and splitting charts for the nurses. Formatting for year round medical record review.
●Created a system for collecting Immunizations, tracking all Immunizations in HEDIS Database, and spreadsheet, outreaching providers to get immunization records, to be uploaded for Supplemental Database.
●Started off-site Liaison Project, going out to Provider’s sites, and working with them to get members into care, using NEXT-GEN, to schedule members.
●Maintain a good public relationship with providers, members, and local health departments
●Set up multiple clinic days for multiple health measures with members
●Make outbound calls to members to assist them with scheduling appointments.
●Worked in Alchemy with looking up member information for current demographics.
Worked in the Medical Health field for 10 years.
●Passed 3 CARF accreditation (Commission on Accreditation of Rehabilitation Facilities), and 3 State Audits.
●Worked Medical Mastermind
●Supervised 5 houses, 15 consumers, and 10 staff members
●Was responsible for Treatment Plans.
EDUCATION: AA DEGREE AT DUNDALK COMMUNITY COLLEGE
CHEMICAL DEPENDENCY COUNSELOR
BRIGHTWOOD COLLEGE-For Medical Billing and Code. Should complete schooling by November 2018.
Skills
Knowledge of Value Based Purchasing Measures, Avaya, CMS Supervisor, CP 9, CPT10, Data entry, HEDIS Database, Epic, Versent, QSHR, Alchemy, Member360, Facets, Bacets, Desktop, documentation, faxes, Medical Record Review, Meetings, Excel, PowerPoint, Microsoft Word, Next-gen, Polices, Public speaking, Quality Management, Audits, treatment plans, Well-organized.
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