HEDIS consultant
Resume:
Victoria B. Stankus
Allegan, MI *9010
acu1eo@r.postjobfree.com
** *****’ medical clinical experience in College health, Orthopedics, OB/GYN, GI, Pediatrics, Family practice, Occupational Health and Oncology.
Competent in EMR, EHR, Excel, Medicare, Medical Claims systems, Microsoft, Outlook, Microsoft Word, Power point and Web-ex.
Proficient in verifying commercial insurances as well as Medicaid and Medicare.
Experienced in Data abstraction, CPT, ICD-9 coding and Medical terminology.
Ability to work independently to reach objectives and goals.
HEDIS Clinical Records reviewer
01/2016 – Present – Maxim staffing
Medical over reading using 2016 HEDIS measures. Supporting HEDIS Operations staff, managers and other office personnel in a matrix environment. Researching claims using ISET, ILEAD and QSHR programs. Using Jabber for incoming as well as outgoing calls to providers for confirmation of members and medical records request. Updating files with the use of Excel spreadsheets and stored data in secured drive. Maintaining confidentiality of members records by following HIPPA guidelines. Over reading over 1,650 charts using vendor software. Using HTA to over read final Market to data collect. Ability to drop current project to assistant in any needed area. Completion of all required learn source registration.
HEDIS Field Reviewer
06/01/2015 – 01/08/2016 – Altegra health
Accurately and efficiently conduct medical record review services. Scanning relevant components of the medical record to support reviews performed. Uploading scanned medical records daily. Maintaining communication lines with Outcomes advocate. Successfully completed required training, testing and quality assessments with HEDIS / PIA. Communicating effectively and professionally with care provider offices, clinics, hospitals, other clinical facilities. Job also required traveling to medical facilities in specified area of region from home to complete review services.
HEDIS Data Abstractor / Medical Reviewer
04/ 01/2015 to 05/30/2015- CSI Companies
Abstracting of Clinical data from Legacy program onto EPIC with accurate and vital information for each patient. Working knowledge of anatomy, physiology, and medical terminology, ICD-9, computer skills and various health care software. Epic, Misys, Fast track and Phoenix.
Diversified Medical / WMU Summer College temp
05/2014 - 09/2014 CRMA
Prep Patients for exams and treatment, medical records, ability to deal with urgent appointments. First aid, EKG, minor office surgery and sterile set up. Scheduling appointments as well as document updates on the status of appointments and notifying patients of completed paper work available for pick up. Obtaining proper paper work needed for physicals, Pap smears, data entry into EMR. Worked closes with health department to document cases.
Holland Pediatrics p.c. Holland, MI/ CRMA
02/2006 – 06/2012 Pediatric staff
Translating English to Spanish, training new employees, medical records, entering information from a paper chart into EMR and MCIR, scheduling appointments, working with various insurances for prior authorization on the phone and online, calling in prescriptions, returning phone calls, faxing notes for referrals, making copies, scanning insurance, entering CPT codes for procedures done in the office. While working at Holland Pediatrics I created a template to assist with patient accuracy in data acquisition. The template served as an example and was adopted as a tool for the practice.
Education:
General Diploma: FENNVILLE HIGH SCHOOL 1994
Certificate Medical Assisting: Grand Rapids Education Center 1996
Lake Michigan College: COMPUTERS/MEDICAL TERMINOLOGY 1997
Certificate: HEDIS training 2015, Medicare A&B coding 2015, HEDIS Training 2016
Skills: Computer literate, medical records, retrieval and scanning, flash drive retrieval, Microsoft outlook, NCQA, Cisco, WebEx, Jabber, Microsoft word, Excel, NextGen, Epic, Cerner, Allscripts, Greenway, ChartsPro, Amazing charts, HEDIS, Knowledge of claims, coding, Medicaid & Medicare part A&B. Ordering office supplies, Ordering Vaccines commercial and VFC, working with drug reps, scheduling lunches, keeping logs of medications, temperature’s and calibration of office equipment.
Awards:
Challenge Scholarship for GPA-1994,
Recognition from Priority health for 98 percent patient compliancy in lead testing- 2003,
Photo in the paper for outstanding customer care-2004,
Recognition for the creation of a template used for insurance and vaccine accuracy-2009,
Diamond eRegognition for performance -2016
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