Nurse Office Staff

Ambra Fey LVN, MHA, CPC, SSYB

Dallas, TX 940-***-**** ********@*****.*** www.linkedin.com/in/ambra-fey-621a32ba PROFESSIONAL PROFILE

Clinical Program/Senior Project Nurse Leader with over 10 years of experience in Medicare, Medicaid, and Marketplace Managed Care with a proven success in Risk Adjustment, Compliance, Regulator, and accreditation. Proven record of accomplishment in operations, program management, project management, and process improvement. Demonstrated effective leadership, innovative problem-solving techniques, and goal-orientated focus to execute business objectives and meet performance expectations. Core competencies include:

Team Leadership

Strategic Planning

Policies & Procedures

Survey Readiness

Quality Assurance

Regulatory Compliance

Accreditation

Management

Startup Situations

CAREER SUMMARY

METHODIST HEALTH SYSTEM 2019 to Present

A leading healthcare system throughout the Dallas Metroplex. Senior Project Leader, Patient Safety and Organizational Readiness. Readiness Clinical Lead that provides expertise in the role of senior project leader for hospital accrediting bodies to include The Joint Commission, CIHQ, CMS, DNVG, and State Surveys.

Knowledge of Regulatory Standards and provided oversite and working knowledge of hospital policies and compliance with identified parameters.

Effectively use project management techniques to prioritize and facilitate projects to align with the organizational strategic goals; work independently to complete projects on time.

Maintain a working knowledge of annual Lab/Hospital Joint Commission Application, Joint Commission Lab/Hospital/BHU Focused Standard Assessment (FSA) and post hospital survey activities.

Assist with development of policies to ensure Joint Commission compliance.

Provides training to administration, managers, employees, and physicians on Joint Commission topics.

Facilitate and oversee the Joint Commission Survey Continual Readiness Team and knowledge of leading TJC Triannual and Disease Specific Certifications Surveys within a large Healthcare System.

Works closely with Presidents, VPs, Director of Nursing and other senior leadership for survey activity, compliance and regulatory.

Lead implementation of Converge Platform tool for Regulatory Reporting and Credentialing. MOLINA HEALTHCARE, INC. 2016 to 2019

A managed care company that provides health insurance to individuals through government programs such as Medicaid and Medicare.

Regional Program Manager of Risk Adjustment

Managed the risk adjustment operations for Medicare, Medicaid, Marketplace, and Dual Eligible across four health plans (TX, NM, OH, NY) under the Regional Director.

Executed member stratification for Medicare and Dual Eligible enrollees to increase efficiency of prospective interventions resulting in $25M incremental annual revenue.

Led projects to included compliance within Joint Commissions guidelines, HIPAA, HEDIS, CMS and coding for vendors, and healthcare policies and procedures. Ambra Fey 940-***-**** ********@*****.*** Page Two

Implemented quantitative and quality metrics with the Risk Department to improve patient safety, compliance management, and operations within the projects.

Implemented multiple programs, including annual comprehensive exams and in-home assessments.

Provided support for Medicare and Marketplace Risk Adjustment Data Validation (RADV) Audits

Created an Unable to Contact protocol, resulting in a 14% increase in member engagement.

Collaborated with regional analysts and actuarial staff to create a robust member logic that identifies high- risk membership with HCC gaps for in-home assessments.

Performed clinical compliance audits, providing feedback to providers and vendors.

Managed staff within Texas and out of state remote office, working directly under the Regional Director. USMD 2011 to 2016

Healthcare system with more than 250 physicians and advanced practice clinicians who provide health care services in approximately 20 different specialties at nearly 50 physician clinics. Clinical Coding Nurse, Senior Care Population Management Managed a health plan contract portfolio of 50 contracts across eight states.

Launched a new Medicare Advantage Plan with 80 providers in 27 clinics across DFW with 10,000 members.

Provided advanced analytical support and financial trending for business operations through the creation of over 15 reports pertaining to provider, member, clinical, HEDIS, and pharmacy data.

Created a “SeniorCare Certification” program aimed to educate office staff.

Optimized Medicare Advantage scores annually almost doubling RAF in 2 years.

Created a RAF template where providers could review documentation at time of service.

Provided EMR/other website training for medical providers, clinical staff, and clerical staff to enhance coding and education for ICD-9-10 coding and CMS claims submissions. Triage Nurse

Triage LVN for 4 provider doctors within a large primary care clinic

Facilitated beneficial patient outreach & education to improve overall care, while flawlessly coordinating communication between hospital staff, doctors, and home health organizations.

Prioritized tasks to include urgent/emergent phone calls and clinical calls.

Maintained complicated EMR scheduling and documentation program.

Floor skills included IV fluid infusion, physical assessments, wound care, and small surgical procedures.

Provided critical care nursing as needed.

VETERANS AFFAIRS 2008 to 2011

Healthcare System providing healthcare to US Veterans and their families LVN

Managed 4 providers’ practices with over 5000 veterans assigned to this clinic.

Worked with the PCP and clinic staff to identify patients with high-risk diagnoses such as CHF, IHD, COPD/Asthma, and Diabetes and ensured clinical guidelines were being followed.

Assisted with answering phones, taking messages, and assisting with patient and staff inquiries.

Administered medications and perform procedures per scope of licensure and per provider order.

Performed miscellaneous duties as requested by the management team within the scope of licensure. PORTSMOUTH NAVAL HOSPITAL 2004 to 2008

The largest Naval Hospital in the US providing care to active duty and retired naval families. LVN, Wound Care Clinic

Managed wound care and surgical assistance to active duty military and family members. Ambra Fey 940-***-**** ********@*****.*** Page Two

Assessed integumentary wounds, applied necessary treatments, provided weekly follow-ups and analyses, through[out] the healing process.

Developed patient treatment plans, conducted initial, and follow up assessments.

Contributed to the patient care team for wound care management during weekly rounds.

Created and observed course of action related to wound care treatment plans.

Consulted with long-term residents and families on treatment goals and plans of care.

Conducted in-house staff education clinics on wound care fundamentals and in-services. EDUCATION

Master of Healthcare Administration and Management, Colorado State University Global Bachelor of Science, Business Administration, Colorado State University Global Licensed Vocational Nurse, ECPI University

Certified Professional Coder, American Academy of Professional Coders Six Sigma Yellow Belt

PROFESSIONAL AFFILIATIONS

Resource Initiative & Society for Education (RISE) American Academy of Professional Coders

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