MANDI DURAN

**** ***** ***** *********, ** ***** Mobile: 330-***-**** Email: ad35yj@r.postjobfree.com CAREER SUMMARY

With over a decade of experience in optometric and managed care, I have a diverse skill set ranging from HEDIS direction for the diabetic retinal exam (DRE) measurement to account and network management, quality assurance and compliance coordination from the perspectives of the IPA, Health Plan, Third Party Administrator (TPA), optical laboratory and eye care provider (ECP). I offer the advantage of broad versatility throughout the healthcare operations continuum, with the proven discipline and motivation to work remotely. In recent years, I prioritized moving “home” to Northeast Ohio to assist aging parents and actively guide my child’s remote learning experience through the global pandemic. Following this pause, I am confident in my ability to bring a renewed sense of energy, dedication, innovation and responsibility to the opportunity at hand and to your organization.

EDUCATION

Youngstown State University: Youngstown, Ohio

Degree: Bachelor of Science in Business Administration in Marketing Management, May 2006 Marketing Core GPA: 4.0/4.0; Overall GPA: 3.6/4.0 - Magna Cum Laude honors graduate TECHNICAL PROFICIENCIES

- Microsoft Office Suite Products

- Google Workspace Cloud Products

- Acuity, Aldera, HSP, Uniflow and WLT Medical Software PROFESSIONAL EXPERIENCE

Argus Dental & Vision, Inc.: Tampa, Florida

Compliance Specialist & Internal Auditor - Remote 04/2019 - 12/2019

- Managed internal audit activity for every major department’s key performance indicators (KPIs) at Argus Dental & Vision, including Claims, Credentialing, Grievances and Appeals, Health Plan Reporting, IT, Provider Relations, Quality Improvement, Utilization Management and Human Resources. This included monthly mock SOC2 audits, random weekly Utilization Management & Grievances and Appeals turn around time reviews, risk assessments, specialized appeals case reviews and more.

- Created new audits for new health plan clients to ensure contractual obligations were met

- Drafted new policies and procedures, prepared responses and materials for new business RFPs and large external audits

- Prepared and presented quarterly summaries of audit findings by department at Compliance Committee meetings and Board of Directors meetings.

Argus Dental & Vision, Inc - Excedis, Inc..: Tampa, Florida 08/2014 – 03/2019 HEDIS Account Manager: Vision - Remote

- Launched HEDIS mobile-DRE program in August 2014 and managed all aspects of measurement compliance, successfully achieving 5-STARS for two key health plan clients, each year under my supervision

- Directed hybrid chart request, abstraction and cataloging strategy for DRE-measurement records, exceeding improvement factor goals and maximizing the bonus potential of our health plan clients; reviewed charts internally and in conjunction with Medical Director for Vision

- Developed internal “Make It Count” campaign beginning in 2016, a series of print reminders for vision network providers to support proper diabetic vision claims coding and chart documentation to encourage HEDIS hits during both the exam and hybrid cycles, as well as foster an open post-exam dialogue between ECPs and PCPs

- Took on a project management role in mid-2018 for Excedis’ proprietary dashboard system: a secure, HIPAA-compliant web portal for member retinal scan images to be reviewed by in-house optometrists and returned to member PCPs with appropriate diagnoses for care gap closure and continuity of care

- Created, managed and updated a complete Business Requirement Document (BRD) to guide the development team’s ongoing dashboard workflow, to ensure timely completion of phased business needs MANDI DURAN

8707 Tahoe Drive Macedonia, OH 44506 Mobile: 330-***-**** Email: ad35yj@r.postjobfree.com

- Engaged in regular module testing with Excedis vision team and IT development team, giving periodic presentations to management and clinical staff to ensure alignment of development expectations, production capabilities and ongoing needs.

-Assisted in the search, hire and development of Excedis’ ophthalmic technician team beginning in 2017, as well as their ongoing training with both Volk Pictor Plus and Welch Allyn RetinaVue cameras

- Assisted in the successful, 100% passage of AAAHC compliance audits in 2016 and 2018, drafting relevant policies and procedures, and administering member satisfaction surveys to all vision screening patients

- Frequently leveraged for time-sensitive projects including RFPs, detailed client analytics and reports, comprehensive educational and presentation materials, both internal and external

- Directly managed full-time employees in HEDIS Support Specialist and HEDIS Coordinator roles

-Developed original content for all annual eye exam reminder campaigns, including both print and telephone Advantica Benefits, Inc.: Clearwater, Florida 04/2012 – 02/2014 Provider Network Representative - Remote

- Assisted vision providers in resolving all concerns, including providing educational in-services on plan administration, fee schedule adjustments, working with IT to amend provider data in medical database, HSP, reviewing EOBs and recommending claims for reprocessing, and liaising regularly with contracted optical laboratory, PFO Global, all for a major, FL-based third-party vision benefits administrator and its clients

- Managed HEDIS mobile vision outreach and scheduling for both providers and IPA groups in 2013

- Tapped to become key representative for several high-volume retail and provider groups including Eye Doctors Optical Outlets, For Eyes, Optimart, Visionworks and NOVA Southeastern University less than one year into job

- Supported all independent and retail vision providers in credentialing contracts for both routine and medical surgical networks, negotiating terms and providing all necessary education in onboarding process

- Conceptualized, designed and implemented a variety of provider educational collateral including the 2013 and 2014 Provider HMO Grids, vision manuals, lab service forms and credentialing documentation forms

- Investigated health plan member grievances, corroborated details with provider, documented findings in Uniflow member data system, and proposed resolutions to Utilization Management or the health plan client

- Conducted periodic site visits as requested by health plans to monitor office compliance standards Infinity Eye Care Center: Tampa, Florida 07/2011 – 04/2012 Public Relations Coordinator and Office Supervisor

- Managed all aspects of account and public relations, general marketing and promotions, and scheduling of optometric services, both in-office and mobile, while additionally serving as the office supervisor for the practice of an independent optometric professional

- Monitored over 30 ALF/SNU/ILF mobile accounts across the Hillsborough-Pasco-Pinellas County area for scheduling of examination services, delivery of eyewear, and continued account-provider relations

- Retrieved and reviewed insurance eligibility documentation for exams and materials prior to all appointments

- Added four high-patient volume mobile accounts in less than one month of holding position, expanding doctor’s overall mobile base with potential to increase spin-off mobile business

- Accepted the additional responsibilities in the role of office supervisor within one month of employment, streamlined systems for patient materials pick-up and organized methods for responsible daily accounting

- Administered payroll via ADP Run Payroll website; verified and approved timecard punches Classic Optical Laboratories: Youngstown and Columbus, Ohio 03/2009 – 08/2010 Territory Manager, State of Ohio

- Managed account relations and field sales for over 200 active laboratory accounts for ophthalmic products, managed care and commercial lab services in State of Ohio

- Established and monitored use of optical laboratory services, while securing and/or expanding HMO program participation and upselling ophthalmic product purchases

- Expanded total territory frame and lens sales for existing accounts in State of Ohio by approximately 15% and 10%, respectively, within one year

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