HEDIS Quality Improvement Medical Records Coordinator

Julie Graves

Phone: +1-832-***-****

Email: ***********@**********.***

PROFESSIONAL SUMMARY

●An experienced HEDIS Coordinator/Abstractor and Pursuant with excellent experience in supporting Clinical Quality Manager(s), HEDIS Project Managers, or Regional HEDIS Managers in fast paced healthcare environments.

●Performed member and provider outreach, verified and confirmed provider demographics & medical record requests, both by telephone and in writing.

●Managed various data organized within Excel spreadsheets, requested medical records and performed follow up of requests within the HEDIS database tool.

●Conducted weekly team meetings throughout the HEDIS Project, followed correct compliant naming conventions then uploaded for Abstractors Review.

●Managed all assigned provider locations to properly pursue active chases, maintained medical privacy for all members to ensure there was no breach in confidentiality.

●Scheduled Onsite record retrieval for team members as requested by provider, oversaw incoming and outgoing fax document.

●Knowledge of ICD-10, Utilized CMCM, Pursuit and Salesforce, Various Record Repositories. Sharepoint, Xceleys, CTT Tracker, QNEX, QSHR; Advanced skill level with Computer and MS Office Applications, Quality Improvement, Risk Adjustment

PROFESSIONAL EXPERIENCE

Aerotek Staffing 1/21- Present

Quality Improvement Specialist

Provide support to medical, behavioral and social support staff to determine needs, eligibility and services for members. Conduct screening and risk assessment interventions per program guidelines.

Identify special needs members through the completion of health screens and other resources.

Work with community outreach/member advocates to coordinate member care.

Educate providers and community resources on program components and available support services.

Educate members with special needs to foster compliance with program and positively impact outcomes.

Conduct site visits as appropriate for programs and provide support to other special programs.

Assist with modification and management of care plans under the direction of a Registered Nurse in conjunction with member, medical consenter or caregiver, Department of Family and Protective Services (DFPS) caseworker and family, if applicable, as well as the managing physician.

Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings. Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.

Aerotek 9/20- 12/20

HEDIS quality Improvement advocate

Contacted providers and members to close COL gaps in care by scheduling appointments for colon cancer screenings either by/with colonoscopies or cologuard kits to be mailed to their homes.

A-Line Staffing 1/20 - 4/20

HEDIS External/Internal Reviewer

Performing data abstraction for HEDIS review collection.

Collected data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement interventions.

Prepared reports and quality improvement studies in an accurate, concise and timely fashion.

Conducted internal auditing for compliance with regulatory and accreditation standards, and monitors and provides consultation to departments to correct deficiencies. Communicates with external data sources as needed to gather data necessary to measure identified outcomes.

Collected and summarizes performance data and identifies opportunities for provider improvement.

Scheduled and communicated with providers office staff in conducting on site visit preparation for medical record retrieval and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).

Pursued methods to ensure receipt of data required for trending and reporting of various QI work plan metrics.

Assisted in activities to prioritize clinical and service improvement initiatives.

Jordan Healthcare Services, Surrounding Houston, Tx 7/19 – 8/19

Personal Care (Hospice) Attendant

Provide Care and comfort to client and their family members while transitioning into end of life care and expectations of events

Display sincerest compassion during declination of clients own self care abilities for life’s essentials during transition of declining abilities

Report any and all changes in status to Nurses and family members

Administration and recordings of all medications for comfort care

Lancesoft, Inc 8/19 - 11/19

HEDIS Abstractor (Contract, Remote)

Project Assistance - including project coordination

Advanced software skills (quickbase, salesforce, SQL, Sharepoint, All Microsoft Office Applications)

Specific HEDIS experience related to HEDIS record abstraction and HEDIS measure review knowledge.

Previous experience copying and uploading HEDIS Supplemental and Hybrid medical records.

HEDIS record abstraction

Closely communicated all issues and concerns to ensure all timeliness and guidelines were met

with the business management department of HEDIS.

Conducted and participated in project coordination and management, in creating special reports or instruction as assigned.

Hospice care for my terminally ill Grandmother 11/18 - 5/19

Healthcare Support 5/18 - 9/18

QSD, Intake Project Coordinator (Remote)

Performed duties as assigned by UHG Clinical Quality Managers, HEDIS Project Managers and Regional HEDIS Managers for market specific annual data collection efforts for Supplemental data

Analyzing and reporting sales data, communicating changes to sales plans, providing knowledge about customers and competitors to Sales Team and Upper Management

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

Performed provider outreach, verifying and confirming provider demographics and medical record requests, both telephone and in writing

Requested medical records and performed follow up requests within HEDIS database tool

Healthcare Support 9/18 - 11/18

Provider Operations Coordinator for Angela Whitlock(Contract)

Supported the Provider Relations Field Representative to achieve department goals

Responded to incoming inquiries from providers and assisted with problem resolution of issues

Outreach to providers to invite to join network and obtain contracting documents

Coordination of credentialing/loading within Sales Force

Reviewed disruption lists to determine provider network status

Managed various data organized within Excel spreadsheets

Healthcare Support, UnitedHealth Group 7/18 - 9/18

Remote Sales Operations Project Coordinator (Contract)

Daily reporting to Sales Team and Upper Management of all pricing data updates, changes or corrections pertaining to managed operational logistics of Sales meeting and activities

Worked closely with Sales team and other operational leaders in developing and maintaining operational infrastructure supporting sales recruiting, goal setting and training for newly contract staff

Processed onboarding, troubleshooting order processing issues and producer requests, as well as sales-related information systems and procedures

Summer season off with my children/preparation for attending college 5/18 - 7/18

Healthcare Support, UnitedHealth Group, Sugar Land, TX 1/18 - 5/18

HEDIS Project Coordinator (Contract)

Performed duties as assigned by UHC Clinical Quality Manager(s), HEDIS Project Managers, or

Regional HEDIS Managers for market specific annual data collection efforts

Managed various data organized within Excel spreadsheets

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

Performed provider outreach, verifying and confirming provider demographics & medical

record requests, both by telephone and in writing

Requested medical records and performed follow up of requests within HEDIS database tool

The Populus Group/Molina Healthcare of Texas, Houston, TX 09/16 – 10/17

HEDIS Specialist I (Contract)

Managed and processed Medical Records

Served as Texas HEDIS SME Trainer

Coordinated and requested medical records from providers

Followed correct compliant naming conventions then upload for Abstractors Review

Researched and corrected records and uploaded in CMCM in order

Taught and instructed team members correct naming convention for all medical records

Assisted Texas team members with their questions and concerns

Conducted weekly team meetings throughout HEDIS Project

Managed all assigned provider locations to properly pursue Active Chases

Maintained medical privacy for all members to ensure there was no breach in confidentiality

Kept all medical records and members personal information in stored locked filing cabinets

Scheduled Onsite record retrieval for team members as requested by provider

Oversaw incoming and outgoing fax documents

Monitored and documented all faxed requests for records and replies in Pursuit Application

Assembled and scan and/or upload documents

Verified all assigned providers contact information; Faxed or mailing medical record requests

Recorded, maintained and distributed minutes of weekly team meeting

Total Private Home Health, Houston, TX 02/12 – 11/16

Personal Attendant Provider

Provided general assistance and support in accordance with clients service plan

Assisted client with activities of Daily Living and reported all changes in status

Provided self- administration of medication reminders and companionship care

Provided transportation for the client as directed by supervisor

Built positive relationships with clients, family members, co-workers and management

Assisted with self-administered medicine, transferred ambulation and meal preparation

Measured and recorded temperature, pulse, and respiration

Demonstrated appropriate knowledge for safe and effective transfer techniques

Assisted and operated DME for patients

Texas Messaging, Houston, TX 10/10 – 02/12

Inbound/Outbound Representative

Promptly and efficiently tasked all assigned incoming communication requests from client patient or family members regarding nature of call in and then processed outbound contacting calls in paging or directly contacting oncall doctors or nursing staff for immediate attention

Processed and maintained all outstanding purchase orders for delivery of care inquiries on a daily basis

EDUCATION

High School Diploma, IH Kempner High School, Sugar Land, TX

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