Nathaline Poquie MPH

Garner, NC ***** • 267-***-**** • adqlir@r.postjobfree.com

Summary

Data Analyst and HEDIS Quality Reviewer with analytical skills in chart review and chart abstraction. Knowledge in Hedis /QRS measures indicators COA, CDC, ABA, BCS, CCS, COL, CBP, WCC, LSC, ADL, CIS, etc

Highly organized Hedis professional with extensive education in public health & healthcare with skills in program management, data gathering and analysis, and reporting.

Background includes HEDIS/QRS, commercial and governmental insurances (MCO & MCD)

Collecting qualitative and quantitative data from a variety of sources and performing analysis to draw useful conclusions.

Able to manage quality control/quality assurances performance improvement initiatives.

Abstracts, codes, and assigns necessary demographic and clinical data elements required for inpatients & outpatient records and entering data into using various software.

Reviewing Medicaid, Medicare patient charts for approval through the HEDIS Program.

Core competencies include

Hedis Data Review and Evaluation

Abstract data from multiple records

Trend Analysis

Charts Review (Both hybrid & Administrative)

Chart Data Abstraction (Both hybrid & Administrative)

Reporting/Presentations

Quality assurances performance improvement

Computer Skills

SPSS & SAS (Statistical Package For Social Sciences and Science Analysis System)

Microsoft Office (Word, Excel, Outlook & PowerPoint)

Epic Systems (Electronic Privacy information Center)

EHR (Electronic Health Records)

Blue e Software

HEDIS (Health Effective Data Information System)

NVDRS (National Violent Death Reporting System)

EMR (Electronic Medical Records)

Cotiviti

Quality Reporter

LK

CITRIX RECEIVER

POWERMHS

FACETS

MEET TOOL ERRORS

QuickWIC

FocusPoint

Agentbot

Xtrac

MyGPS

Professional Experience

Customer Relationship Advocate 2021 -2022

Fidelity Investments

Provide outstanding client service with a “one call resolution” handling inbound calls daily while demonstrating empathy and problem-solving skills

Practice active listening and open-ended dialogue to gain a thorough understanding of the client’s financial needs

Ability to establish rapport with clients over the phone to create long term relationships

Worked in a collaborative, team-based culture, building a career

Provided a high level of attention to detail to adhere to stringent investment policies, procedures, and guidelines

Assisted clients with a broad range of needs including answering questions about their account balances to guiding them to the appropriate resources.

Help customers feel more confident, make clearer decisions, and achieve their own financial dreams.

Membership Professional II (Provider Information Analyst)

Blue Cross Blue Shield NC (Spectraforce Technologies Temporary Staffing), Durham, NC June 2020 – Present

Accurately complete provider enrollment, terminations, demo changes and contracts in provider systems of record to ensure appropriate claims payment in accordance with contractual language.

Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.

Communicate, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.

Research, respond to, analyze and resolve complex claims issues related to provider setup and provider eligibility on a daily basis.

Create resolution documents to address provider issues and increase provider satisfaction. Utilize probing and problem-solving methods to resolve all inquiries/requests. Identify, understand, and anticipate providers’ unexpressed needs and concerns.

Provide cross functional support and serve as Subject Matter Experts (SMEs) or second tier resolution to internal and external provider teams (i.e., PSA team, Credentialing, Contracting, Provider Service Consultants, etc).

Manage timely responses to external provider inquiries and requests. Evaluate new service requests from providers to determine appropriate actions for recording into the systems of record.

Perform gap analysis on requests and follows through with communication and/or education to providers on internal client process and issues.

Recommend, and participate in process improvement opportunities for Primo Operations. Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives, and solutions.

HEDIS Data Collection Reviewer

Blue Cross Blue Shield NC (Spectraforce Technologies Temporary Staffing), Durham, NC Feb 2020 – April 2020

Abstract, Review & analyze medical records of HEDIS data collection

Validating knowledge of the collection process and ensuring Hedis data collection accuracy

Track daily HEDIS work log

Index, NCQA Standards, HEDIS audits and medical records reviews.

Establishes regular meetings to track progress.

Ongoing medical record reviews and abstractions.

Following appropriate procedures for coordinating, scheduling, and requesting the needed medical records.

Working independently to review and abstract pertinent medical record information.

Collaborating with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits.

Fax request for medical records to review and doctor offices follow-up

Locate and review all assigned medical charts

Perform abstraction and save all chart documentation per HEDIS 2019 specifications

Enter all applicable information into the electronic Medical Record Review tool as required

Participate in a daily call to review over-reading observations and technical/system updates

Consistently demonstrate high standards of integrity by supporting mission and values

Maintain high regard for member privacy in accordance with the corporate privacy policies and procedures.

Maintain HIPAA standards and confidentiality of protected health information

Perform other functions as assigned by management

Public Health Data Analyst/Program Specialist – Prescription Drug Monitoring Program

Pennsylvania Department of Health, Remote/Harrisburg-PA December 2017-August 2019

Collect, review, and analyze data on opioid-related and non-opioid-related deaths from coroner records, law enforcement reports, autopsy reports, and laboratory records. Examine data on-site at coroner/medical examiner/law enforcement offices and data included in records provided to PDMP office by targeted counties.

Enter information about opioid- and non-opioid-related deaths into Pennsylvania Violent Death Reporting System (PA-VDRS) and State Unintentional Drug Overdose Reporting System (SUDORS), adhering to applicable national guidelines.

Track completion of project milestones, ensuring delivery within deadlines; Review and abstract approximately 30 cases per day. Perform case reconciliation and ascertainment (final review).

Meet with representatives of various agencies within the PA health innovation department, including managed care bureau, violent death recording system, health/statistics, and health planning.

Led team that created data abstraction forms in Epi Info and completed quality check reports. Distributed project tasks, trained team members, and evaluated performance. Compiled single quality check report based on team’s work and submitted to the CDC.

Enrollment Specialist (Temporary Position)

Public Partnership Public Consulting Group, Remote/Harrisburg-PA August 2017-December 2017

Assisted individuals covered by Medicaid with processes associated with hiring their family members as caregivers.

Distributed program materials describing Medicaid benefits.

Met with prospective partners individually and in groups regarding obtaining employment through Medicaid.

Explained to clients that they would be employing caregivers and would hold responsibility for hiring and firing.

Demonstrated correct ways to fill out employment paperwork.

Educated clients and caregivers on use of the Time4Care app.

Quality Assurance and Integrity Specialist Intern – Bureau of WIC Division

PENNSYLVANIA DEPARTMENT OF HEALTH, Harrisburg, PA May 2017-July 2017

Investigated WIC participant fraud and vendor compliance.

Collected data from WIC database and other sources; analyzed data to detect extravagance, fraud, and noncompliance with laws/management policies. Evaluated trends and prepared reports.

Participated in vendor compliance investigations, ensuring holders of WIC vouchers purchased only WIC products and that vendor accepted vouchers for appropriate purchases. Findings resulted in fines or vendors’ removal from program.

Investigate WIC participant fraud on various vendors sites, online sites and Smartphone APPS

Participate in data collection and analysis pertaining to WIC fraud

Communicated with WIC participants and vendors concerning WIC food instruments

Carried out QA inspection functions as assigned by the QA manager

Prepared detailed reports on audit findings of violation, Review and Ensure thoroughness.

Accuracy and pay attention to details in record keeping, while maintaining efficiency in the office

Packaging Operator

GSK (Randstad Temporary Staffing Agency) Marietta PA June 2016 – September 2016

Comply with all operational safety, process safety, environmental permits, Quality policies, procedures, and training requirements.

Trained to use all production documentation (Production forms, batch records, SOP’s, Work Instructions) to ensure compliance to regulatory requirements.

This also includes MyLearning SOP’s as well as practical training (OJT). Assist and follow SOP’s, change control / validation processes, and adhere to established cleaning programs for GMP compliance.

Complete batch record documentation monitoring Right First-Time results and related Key Performance Indicators.

Assist in the generation of measurements to track efficiencies and other pertinent data for the unit to identify and implement continuous improvement efforts. Report all safety concerns and hazards immediately and operate work saver as needed.

Ensure quality and compliance in accordance with established procedures and standards of the Quality System.

Phlebotomist

Labcorp, Columbia-MD February 2008-July 2012

Collected samples and prepared DOT/non-DOT testing, biometrics screening, health/wellness screening, paternity testing, specimen aliquoting, and insurance-required screening.

Entered data, prepared financial documents, and managed billing.

Provided excellent customer service and answered calls.

Office Manager

FLAGSHIP REHAB, Cumberland-MD June 2006-February 2008

Abstracting patients information from medical files and distributed clinical records

Data entry, billing of client insurance, filed document, fax, answered incoming calls,

Audited evaluations and recertification by the therapists

Created new admission charts, Processed clinical record for admissions and discharges

Clinical Care Associate

PENNCARE MEDICAL ARTS, Levittown -PA September 2005-June 2006

Abstracting patients information from medical files, Charts reviews and distributed clinical records

Performed data entry, customer services, registration, scheduling, order entry and other office miscellaneous duties

Drew blood, gave therapeutic injections and vaccines and took patient blood pressure and pulse

Took patient temperature and respirations; performed EKGs, urine dipsticks and breathe test.

Education & Credentials

Liberty University Lynchburg, VA - 2017

Master of Science in Public Health/Global Health

Master of Public Health in Nutrition

Strayer University Trevose, PA - 2014

Bachelor of Business Administration

Cittone Institute Philadelphia, PA - 2005

Medical Assistant Diploma

Compliance/Fraud Investigations

Extract relevant information from medical records

Multitask and troubleshoot problems

Stakeholder Engagement

Behavioral Health & Safety

Advocacy/Community Awareness

Community Involvement

Pennsylvania Department of Health - Present

Symposium Committee - Present

State Employee Combined Appeal (SECA)- Present

Public Health Data Abstractors Org - Present

American Red Cross - Present

American Public Health Association – Present

Certifications

Electrocardiography Proficiency Certificate - 2005

American Red Cross, CPR valid through - 09/2016

HLTI Solution Learning & Marketplace - 2019

HEDIS Field Reviewer Certification

Change Healthcare - 2019

Medical Record Reviewer Certificate

Contact this candidate