Frances I. Felipe

Miami, FL - *****

(Fully vaccinated)

Professional Summary:

Highly motivated, dedicated professional with 15 years of experience in practical nursing.

Strong foundation in patient education, medical/surgical nursing and pharmacology.

Passed HEDIS/STARS and the National Committee for Quality Assurance (NCQA) training.

Knowledge of HEDIS measures, and QSHR and QNTX software programs and ICD coding and billing.

Able to review others’ work and provide appropriate feedback.

Experience in admission assessment process and case management.

Able to navigate and master software programs.

Fully bilingual Spanish/English.

Knowledge of Medicare and Medicaid regulations and guidelines.

More than 15 years’ experience in the medical field.

Strong ability to read and interpret medical documents.

Demonstrated superior accuracy in patient history, charting, and other documentation.

Education:

High School Diploma

2008

American Medical Academy - Miami, FL

2014

Skills:

HEDIS Review

NCQA

QSHR

QNTX

EPIC

EMR Systems

Pain Management

Aseptic Technique

ICD-10

Triage

CPT Coding

ICD-9

Medical Office Experience

Critical Care Experience

Employee Orientation

Patient Care

Anatomy Knowledge

Medical Scheduling

Medical Terminology

Medical Records

Utilization Management

Management

Microsoft Office Suite (Word, Excel & PowerPoint)

Adobe reader

Medical Billing

Supervising Experience

Auditing

Nurse Management.

Professional Experience:

United Health Care - Miami, FL

Apr 2021 to Aug 2023

HEDIS Nurse

Performed seasonal medical record review of HEDIS data according to NCQA requirements and project guidelines while achieving production goals.

HEDIS Abstraction/Research.

Skilled in clinical data abstraction.

Ensured HIPAA compliance.

Perform health risk assessments over the phone.

Update medical records via ICUE and MIIM.

Medical Record review.

Schedule medical appointments and transportation services.

Recognized as top producer with excellent customer service.

Educate patients and their families on therapeutic regimens, including medication and pain management.

Implementation: Followed aseptic procedures and provide care in accordance with universal precautions.

Worked effectively with an interdisciplinary team and performed accurate charting procedures on surgical/traumatic wound care, intake and output, catheter insertion,

ostomies, trach care AND Geriatric Care

Tracheostomy care, IV Access Lines care, renal I & O catheterization, wound and burn care, geriatric

basic care, medication administration, and respiratory treatment therapy.

Member 360 EPIC.

Knowledge of all Medicare measures.

Actalent with Simply - Miami, FL

Oct 2022 to Apr 2023

HEDIS Nurse Abstractor

Performed seasonal medical record review of HEDIS data according to NCQA requirements and project guidelines while achieving production goals.

HEDIS Abstraction/ Review.

Medical Record Collection.

EMR.

Abstracting medical records.

QSHR.

EPIC.

Member 370.

Stars.

All Medicare measures.

CHSI Subcontracted By the Federal Government - Homestead, FL

May 2019 to Nov 2019

Pediatric Nurse/Case Manager

Intake call from hospitals, ensure readiness of room, equipment and supplies for incoming patients to the center.

Reviewed discharge documentation, medical information, diagnosis, laboratory results, medications, dietary needs and insurance information.

Contacted patient’s primary physician for admission authorization and initiation of services.

Wound care and Patient education

Performed complete head to toe assessment, including mental assessment.

Referral to Specialist.

Vaccine administration and Florida shots data entry.

Reviewed and recommended additional services when necessary.

Contacted patient’s doctor to inform of findings.

Medication administration.

Monitor, document and report any adverse or side effects of medications.

Performed case management, monitoring and discharge planning.

Harmony Healthcare - Miami, FL

April 2015 to May 2018

Psych Nurse

Assessment: head to toe assessment including neurologic, cardiovascular, respiratory and gastrointestinal.

Planning: Educate patients and their families on therapeutic regimens, including medication and pain management.

Implementation: Followed aseptic procedures and provide care in accordance with universal precautions.

Evaluation: Worked effectively with an interdisciplinary team and performed accurate charting procedures on surgical/traumatic wound care, intake and output,

catheter insertion, ostomies, trach care and Geriatric Care.

Tracheostomy Intake call from hospitals, ensure readiness of room, equipment and supplies for incoming patients to the center.

Reviewed discharge documentation, medical information, diagnosis, laboratory results, medications, dietary needs and insurance information

Contacted patient’s primary physician for admission authorization and initiation of services.

Performed complete head to toe assessment, including mental assesment.

Reviewed and recommended additional services when necessary.

Contacted patient’s doctor to inform of findings.

Performed case management, monitoring and discharge planning.

Nursing and Rehabilitation Ctr, Mercy Hospital - Miami, FL

Oct 2014 to Apr 2015

Direct Care Nurse

Assessment: head to toe assessment including neurologic, cardiovascular, respiratory and

gastrointestinal.

Planning: Educate patients and their families on therapeutic regimens, including medication and pain

management.

Implementation: Followed aseptic procedures and provide care in accordance with universal

precautions.

Evaluation: Worked effectively with an interdisciplinary team and performed accurate charting

procedures on surgical/traumatic wound care, intake and output, catheter insertion, ostomies, and trach

care.

Geriatric Care

Tracheostomy care, IV Access Lines care, renal I & O catheterization, wound and burn care, geriatric

basic care, medication administration, and respiratory treatment therapy.

Med Surge Duties include: rehabilitation support functions, cast care, pin care, traction care, chest, NG,

nephrostomy, gastro tubes, tracheostomy care, ICU, OR,

ER, GI patient care, triage ER patients, renal I & O catheterization, urinalysis, culture and sensitivity,

wound and burn care.

Los Jazmines Home Health Care - Doral, Florida

Mar 2007 to Dec 2012

Medical Biller

Intake call from hospitals, ensure readiness of room, equipment and supplies for incoming patients to the center.

Reviewed discharge documentation, medical information, diagnosis, laboratory results, medications, dietary needs and insurance information.

Contacted patient’s primary physician for admission authorization and initiation of services.

Billing/ Coding.

Medical Office/ Eye Clinic - Cutler Bay, Florida

Apr 2004 to Jan 2007

Office Manager/ Medical Biller

Intake call from hospitals, ensure readiness of room, equipment and supplies for incoming patients to the center.

Reviewed discharge documentation, medical information, diagnosis, laboratory results, medications,

dietary needs and insurance information.

Contacted patient’s primary physician for admission authorization and initiation of services.

Billing/Coding.

Certifications and Licenses:

CPR Certification

BLS Certification

LVN

Contact this candidate