Data Collection Quality Improvement

Angela Hurt

Professional Summary

Healthcare professional with 8+ years’ experience with HEDIS/Data abstraction

Responsible for data collection, abstraction, and over-reads for company quality improvement performance measures

Lead data collection, abstraction, and over-reads for company quality performance measures, including HEDIS, Adult and Child Core Set and other custom measures

Worked with HEDIS team to collect member records

Conducted reviews/over-reads of records to determine if record meets HEDIS criteria and/or was reviewed correctly

Reviewed, created, uploaded, and researched spreadsheets to provide updated data

Ensured documentation completed with 110% accuracy

Prepared correspondence and reviewed documentation for conformance with internal policies and procedures

Maintained files, ordered supply, coordinated meetings, and compiled and distributed meeting minutes

Advanced knowledge of Microsoft Office (Word, Excel, PowerPoint, Outlook) HEDIS, Change (Altegra) Health Alert Portal, CIOX, HUI-Q, QSHR, Gateway, GRITS, GAHIN, EPIC, Affinity, NextGen, ICD-9, and ICD-10, DATAVANT, OPTUM, Amisys, Centene Connect

Available to interview with 24-hour notice

Lives in Atlanta, GA looking ideally looking for hybrid work conditions

Professional Experience

Centene, Peach State Health Plan

12/2023 – 5/2024

Quality Improvement Coordinator

Referenced NCQA Education and Training Resources, NCQA Quality Measures for HEDIS daily

Responsible for data collection company quality improvement performance measures utilizing Datavant, OPTUM, Amisys, Centene Connect

Lead data collection and for company quality performance measures, including HEDIS, Adult and Child Core Set and other custom measures

Conducted reviews of records to determine if record meets HEDIS criteria and/or was reviewed correctly

Placed the results collected into

specific data base

Handled telephonic interaction with provider offices/member

Assisted with the development and

coordination of all core health services

Followed NCQA guidelines

06/2022 – 12/26/2023

DCM Program Coordinator / Program Coordinator (Inbound / Outbound Calls)

Outreach 60-70 daily PSHP Members and complete Assessment/Screening assigning Members for Telephonic or Digital Case Management utilizing Wellframe

Communicating detailed information for Members understanding of Case Management and PSHP services

Utilized TruCare, Interpreta, Impact Pro and GAMMIS to identify Members claims, eligibility, providers. DOS. Procedures and engagements

Instruct, answer and discuss any questions or concerns for members on how to download Wellframe Application

Create Case, Task, Referral to assign Members a Case Manager BH or PH, and HROB

Answer Inbound calls to address callbacks

Provide written and oral communication using TEAMS, Outlook, Avaya - Telephonically

Review claims for DOS, procedures, diagnosis, IP, ER, OP, psychological and dental visits

During receipt of call verify HIPAA Identifiers a minimum of three out of five

11/2021 – 5/2022

Quality Improvement Coordinator

Responsible for data collection, for company quality improvement performance measures

Lead data collection for company quality performance measures, including HEDIS, Adult and Child Core Set and other custom measures

Worked with HEDIS team to collect

member records

Conducted reviews of records to determine if record meets HEDIS criteria and/or was reviewed correctly

Placed the results collected into a

specific data base

Handled telephonic interaction with provider offices / members

provider offices/members

Assisted with the development and

coordination of all core health services

Followed NCQA guidelines

Progressive Insurance

6/2021 – 11/2021

Customer Care Representative

Responsible for answering and forwarding 60 calls per day utilizing Avaya Phone System

Processing personal injury claims for insured and claimants, agents, and law offices

Utilizing SoClr software, Microsoft Teams, Outlook, Avaya Communication

Centene – Arkansas Health &Wellness Plan

3/2021 – 5/2021

Quality Improvement Coordinator

Responsible for data collection, and over-reads for AR Health and Wellness Plan quality improvement performance measures

Lead data collection and over-reads for company quality performance measures, including HEDIS, Adult and Child Core Set and other custom measures

Utilized QSHR researching for alternate chases

Submitted SR Tickets when applicable

Worked with HEDIS team to collect member records

Conducted reviews/over-reads of records to determine if record meets HEDIS criteria and/or was reviewed correctly

Placed the results collected into a specific data base

Handled telephonic interaction with provider offices/members

Assisted with the development and coordination of all core health services

Followed NCQA guidelines

UnitedHealth Group

1/2019 – 3/2021

Project Coordinator

Supervised and trained to research claims and DOS utilizing iSET

Updated data, checked and maintained all chases including scheduled, unscheduled, active, pends, and overdue chases in RateLift

Checked and reviewed received medical records in OnBase

Entered QSHR working with various projects to research and locate alternate providers for all measures

Communicated utilizing Jabber, IM, Outlook, WebEx, and Word

Reviewed, created, uploaded, and researched spreadsheets to provide updated data

Ensured documentation completed with 110% accuracy

Interacted with team members, providing assistance and knowledge

Utilized References in QSD Education & Training Resource Center, NCQA Updates Quality Measure for HEDIS, 2018 Tech Specs

Researched VTB to resolve and correct alternate chases

Utilized Change Alert Healthcare Portal reviewing compliant and noncompliant measures, review entered communication and locate providers and alternate providers

Faxed medical record request utilizing RightFax and e-Fax

Completed required training and Learning Source courses

Pinnacle Technology - UPS

7/2019 – 3/2020

Pricing Specialist

Reviewed and maintained all Add/Deletes and Conflicts Accounts

Reviewed Addendum, Amendments, and Implementation Checklists with Corrective Worksheets

Entered data in Enterprise and SPPQRS Analyzers with 110% accuracy

Compiled and maintained weekly Bid Expiration Report for over 500 accounts

Extended Bids as necessary and review for extended process

Utilized IAS, DWH. BIA and Workflow, Share drive data

Communicated and interacted with 20 Enterprise Account Managers and Directors

Communicated utilizing Jabber, IM, Outlook, WebEx, and Word.

Reviewed, created, uploaded, and researched spreadsheets to provide updated data

Ensured documentation completed with 110% accuracy

Interacted with team members, providing assistance and knowledge

Utilized Reference books, Notes, Weight and DIM guidance for accuracy utilizing Rate Chart Guide

Completed required training

Centene – Peach State Health Plan

1/2017 – 10/2017

HEDIS Coordinator

Ensured HIPAA guidelines met using three out of five identifiers

Outreached 60-70 Providers, Vendors and Members daily via telephone discussing medical records and/or care management

Interpreter requested as needed to assist with communication

Responsible for data collection for company quality improvement performance measures

Discussed Care Management with PSHP Members

Lead data collection for company quality performance measures, including HEDIS, Adult and Child Core Set and other custom measures

Worked with HEDIS team to collect member records

Conducted reviews of records to determine if record meets HEDIS criteria and/or was reviewed correctly

Placed the results collected into a specific data base

Handled telephonic interaction with provider offices/members

Assisted with the development and coordination of all core health services

Followed NCQA guidelines

Iron Mountain

3/2016 – 8/2016

Image Processor and Release Information Specialist

Researched and resolved customer issues

Modified work procedures as needed to meet customer demand

Managed project timelines, quality, and outcome of customers’ orders

Provided accountable standards and measures to the department employees

Performed time studies for Sales/Account Management

Ability to assist in the invoicing process

Amazon

11/2015 – 5/2016

Part-Time Fulfillment Associate

Wrapped packages for shipping

Sorted and scanned package to package and ensured destination delivery

Inspected wrapping of pallets for safety to dock and delivery

Utilized pallet jack to move pallets to correct destinations

Studied and followed the OSHA guidelines

Cleaned and secured the working area and environment

Trained and instructed employees

Followed instructions and provided assistance as needed

Separated packages for lane delivery

Sorted small packages

Anthem

6/2014 – 8/2015

Administrative Assistant

Provided customer service to all customers

Responsible for providing high level administrative support to an individual or department

Researched and verified information pertaining to reports

Prepared/tracked budgets

Created databases and analyzed moderately complex data

Supported projects by assisting manager/department, built and maintained project plans, scheduled and contributed to meetings to ensure project deliverables are met

Prepared correspondence and reviewed documentation for conformance with internal policies and procedures

Maintained files, ordered supply, coordinated meetings, and compiled and distributed meeting minutes

Handled travel arrangements and expense reports

Screened, handled, or distributed incoming calls and complaints

BlueCross BlueShield

4/2008 – 5/2014

RHIT HEDIS Quality Project Coordinator Contractor

Verified member’s HMO, PPO, POS and Medicare plans

Used customer service skills while assessing patients

Worked with HEDIS Guidelines

Daily reviewed ICD-9, ICD-10, CPT, HCPCS codes

Trained and instructed 3-4 employees utilizing Pursuit Tool, MRRS, Mediconnect, BCBS QCare and Microsoft Word

Searched compliance for members using Medical Record Review

Contacted and spoke daily with office medical staff and physicians in medical facilities

Received and obtained member information to be reviewed by National Committee for Quality Assurance (NCQA) for the HEDIS Project

Utilized Pursuit Tool entering data and specificity for each medical office record

Entered data in Excel spreadsheet and fax documentation

Practicum

11/2010 – 5/2011

Health Information Technology Internship

Utilized five (5) Medical Facilities Portals including McKesson-Med Host VP, CISCO, SSL, VPN downloading Medical Records to process claims using FOB security keys

Updated addressees in Centricity - IDX Billing System

Reviewed and processed EOBs, COBs, and medical records for commercial insurance and worker’s compensation claims

Reviewed documents for accuracy; update information

Aware of and maintained confidentiality utilizing the HEDIS, HIPAA, JCAHO, JCO and PHI regulations

Reviewed documentation and completed in a timely manner with 99 percent accuracy

Familiarity with tabular, alpha, and procedural codes using ICD-9, ICD-10, CPT, HCPCS and MS-DRG

Education

Atlanta Technical College

Associates Degree in Health Information Technology

Atlanta Technical College

Medical Coding Certificate

Booker T. Washington High School

High School Diploma

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