MARQUISA S. JOHNSON

Charleston, SC

843-***-****

adij4j@r.postjobfree.com

OBJECTIVE

Seeking a stable full-time human services position that would help to utilize my experience, knowledge, and education to improve Individual and population health.

EDUCATION

University of the Cumberlands – Bachelor of Science in Human Service May 2018 to August 2020 Limestone College- Associate Degree in Liberal Arts August 2008 to May 2011 Healthcare Effectiveness Data and Information Set (HEDIS) Certification – January 2018-Present 2020 RELEVANT EXPERIENCE

Remedy Staffing (Logistics Health – Optum Serv Federal Health Service) – 10/2020 to Present

Credentialing, and/or privileging for practitioners and facilities as applicable for COVID project

Conduct research and provide summaries as requested for various provider types, facilities, or payer entities

Tracking and maintenance of all supportive and required documents for facilities or practitioners

Maintain and document activities for all assignments in credentialing software

Review credentialing files and work with healthcare providers to obtain missing, incomplete, and expiring items.

Perform Background Checks, Active License requirements, malpractice insurance, CPR, COVID testing, release forms, and other confidential requirements

Establish and maintain long-term working relationships with healthcare providers to ensure customer satisfaction and retention.

Maintain consistent contact with healthcare providers to ensure that expectations are clear and requirements are completed in a timely manner.

Utilize advanced problem-solving skills to resolve issues and conflicts that may arise. AIM Medical Consultant Services, LLC – HEDIS Abstractor/Data Analyst Lead (Remote)– 07/2020 to Present

Responsible for analytic data needs of the business unit. Handle complex data projects and acts as a lead for other Data Analysts.

Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, external reporting

Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources

Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.

Develop reports and deliverables and make recommendations to management

Model data using MS Excel, Access, SQL, and/or other data warehouse analytical tools

Assist management in driving business decisions based on data

Ensure compliance with federal and state deliverable reporting requirements by performing data quality audits and analysis.

Assist with training and mentoring other Data Analysts.

Assist with determining workload and related activities for other Data Analysts Randstad – K12 – Document Processor (Remote) 05/2020 to 06/2020

Process, verify, and maintain information associated with prospective and existing student accounts, student activity and enrollments.

Adheres to the Document Processing guidelines and procedures outlining quality and productivity expectations as well as attendance expectations.

Experience with Salesforce

Ensure school and state compliancy guidelines are met for all incoming enrollment documents

Enter enrollment documents such as transcripts, birth certificates, proof of residency, and immunizations into student records system

Establish secure access to student records with sensitive information (e.g. special education documents)

Proactively update the supervisor of assignment status and any delays

Perform organizational clerical tasks and other tasks as needed Total Med – United Healthcare Group-Optum (Remote) - HEDIS Abstractor & Over Reader- 01/2020 to 05/2020

Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards

Abstract from medical records received online by a vendor for the HEDIS project (Change Healthcare, AdvantMed, Ciox, OnBase)

Review medical records and Overread for HEDIS and other measure sets in compliance with standards

Track and report on issues and outcomes related to abstractions and over-reads

Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required Medlink 1099 Independent Contractor (Anthem) (Remote) – HEDIS Abstractor – 12/2019 to 05/2020

Abstract from medical records received online by a vendor for the HEDIS project

Perform data entry of all assigned medical records into the applicable software system

Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards

Review medical records and abstract data for HEDIS and other measure sets in compliance with standards

Track and report on issues and outcomes related to abstractions and over-reads

Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required

Knowledge of onsite electronic medical record systems

Reviewing medical records to capture appropriately documented numerator events (e.g., blood pressure readings, eye exams, cervical cancer screenings etc.)

Experience and ability to utilize a certified HEDIS software The CSI Company - United Healthcare Group-Optum (Remote) – HEDIS Abstractor/Over-Reader 07/2019 to 11/2019

Performs medical records abstraction in support of annual: The Healthcare Effectiveness Data and Information Set (HEDIS)

On an annual basis develops expertise in the requirements and parameters of mandated external Accountability Set (EAS) performance measures

Applies structured auditing criteria to medical records to determine compliance with standards of the EAS.

Accurately enters the results of chart audits into a database (e.g. Quality Reporter); Monitors progress towards completion of the annual HEDIS chart abstraction process

Maintains a less than 2% error rate in record abstraction and data entry.

Utilizes various software applications (Quality Reporter, Excel, and Word) to support HEDIS operations. Della Info Tech - AmeriHealth Caritas-Select Health of South Carolina (Charleston, SC) (Remote) – HEDIS Abstractor – 01/2018 to 07/2019

Develop and provide reports and cost-benefit analysis tools to meet QI requirements and uses automated software tools and processes to help streamline activities and improve data/analytics for the quality team.

Develops, codes, runs, and/or prepares formatted reports to support critical Quality Improvement functions (e.g., reporting for key performance measurement activities, including HEDIS, state-based measure reporting and medical record review)

Collaborates and / or assists in performing quality assurance checks on reports prior to completion

Works with Director and / or Manager to establish and / or document quality assurance process checks to be utilized by all staff to ensure the integrity, completeness, and validity of external and internal reports

Collaborates with department leads and other partnering departments to understand and / or document business requirements and / or implement required reporting.

Collaborates with other department staff to convert HEDIS data sources for use in HEDIS reporting as needed.

Assists program managers with research regarding performance measurement outliers when asked.

Develop Performance Improvement projects to improve clinical quality and performance measure outcomes

Assist with delegation oversight audits and coordinate corrective action plans to ensure compliance with all state, federal, contract and accreditation requirements

Conduct training and education programs for Plan, provider network, delegated vendors to support NCQA and HEDIS activities

Della Info Tech - AmeriHealth Caritas Select Health of South Carolina (Charleston, SC) – GED Coordinator/Outreach Coordinator – 01/2018 to 01/2019

Onsite coordination for eligible members on the Select Health of SC plan

Respond to student inquiry/intake process and assessment of ongoing progress

Support students internal and external social service needs

Reviews curriculum and teaching materials to assist member

Helps develop and maintain program systems and procedures, assist with any lifestyle barriers

Assists with program-related communications: phone calls, texts, and emails.

Coordinates student and tutor scheduling with member’s local adult educational center Della Info Tech - AmeriHealth Caritas Select Health of South Carolina (Charleston, SC) – HEDIS Administrator – 12/2016 to 01/2018

Scan medical records into Select Health database; Manage, organize, and assist with the HEDIS program, organize, and manage health information data.

Retrieve records from EMR site, right fax, or email and verify; upload documents to Sharepoint

Provide administrative support to other departments. Plan meetings, travel arrangements, appointments, memos, emails, and other communications amongst departments.

Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation.

Assist with behavioral health mailing (ADHD, ADD, and AMM), issue gift card vouchers to qualified members

Assign and record new record numbers; verify existing record numbers; input and record locations to computer.

Conducts claims research, determining correct service location or verifying member history

Performs provider outreach, verifying and confirming provider demographics & medical record requests, both by telephone and in writing

Requests medical records and performs follow up of requests within database tool

Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software (e.g., MS Word and Excel)

The Mentor Network – South Carolina MENTOR (Charleston, SC) - Recertification Coordinator – 06/2015 to 12/2016

Perform background checks, Central Registry, Sex Offender, OIG, request fire inspections, and social media checks on all new and established Mentors.

Must maintain therapeutic foster care caseload of mentors without Clients.

Audit Chart records to maintain compliance with state and federal regulations.

Utilize agency pre-service training model and or therapeutic requirements (when applicable) to train foster families for applicable region.

Maintain contact with potential or current families in training, including returning phone calls

Maintain contact with families interested in becoming licensed as foster parents at weekly intervals or as determined by the trainer

Collect and review all state and agency required documentation needed for foster parents to gain licensure

Able to assess safety, family strengths and needs, access community resources, and assist foster family in preparing to provide a safe and nurturing environment

Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software (e.g., MS Word and Excel

Techlink Systems - AmeriHealth Caritas Select Health of South Carolina (Charleston, SC) – HEDIS Specialist– 03/2014 to 10/2014

Scan medical records into Select Health database; Manage, organize, and assist with the HEDIS program, organize, and manage health information data.

Retrieve records from EMR site, right fax, or email and verify, Knowledge of QSHR, Jive, and Faucets/Streamline

Experience with abstracting clinical information from medical records; experience in women’s health care, diabetes, pediatrics

Maintain electronic and hard copy filing system, retrieve documents from filing system, handle requests for information and data; upload documents to Sharepoint

Retrieves medical records by following chart-out procedures; documenting reasons charts cannot be retrieved for follow-up purposes.

Serves and protect PHI by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.

Assists the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review. Medical University of South Carolina (Charleston, SC) – Unit Secretary (Trauma/Med Surgery, Intensive Care Unit, Labor/Delivery, Antepartum, Postpartum, Pediatric Surgery) – 06/2012 to 06/2015

Duties include answering calls, copying documents, sending fax, and ordering hospital supplies for the unit; Handle the secretarial duties of all the doctors on the unit, File, organize and label all clinical test given to the patient

Keep records of the patients’ documents at the time they admit and discharge from the hospital

Registering patients in IDX/Sunrise system, communicate through EMR systems: Epic, McKesson, or IDX systems

Admit patients, manage, and maintain patient records, break down medical charts for record keeping and coordinate billing

Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software (e.g., MS Word and Excel)

Skills

HEDIS

SQL

Microsoft Excel reporting

Data entry and verification

Data analysis

Supplemental Data

Claims analysis

Auditing

Quality

Quality Intelligence Suite

Medicaid & Medicaid Policies

Medicare Risk Adjustment

Utilization management

Relational databases

Microsoft Access

Data collection

Analysis skills

Project management

Data modeling

Debugging

Root cause analysis

Documentation review

Tableau

Data mining

Process Improvement

Public health

Strategic planning

Data analytics

Relational databases

Managed care

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