Medical Billing Practical Nurse
Resume:
SSRELLE K SAIKALY, LPN
Akron, Ohio ***** · 330-***-****
**********@*****.***
PROFESSIONAL SUMMARY.
HEDIS Nurse with over 10 years of experience in workflow development as well build experience in various medical software modules. I have gained knowledge and skills in security (HIPPA), meeting the requirements of Joint Commission, document imagery, release of information and abstracting clinical data. I am qualified for the positions in my field because I exude integrity and have a proven ability to support and deliver excellent auditing to Physicians and Clinical Staff and delivering 98% accuracy on HEDIS charts.
PROFESSIONAL SKILLS
Recent and related experience working with HEDIS Measures ABA, WCC, CBP, COA, MRP, CDC, PPC, CIS, LSC, IMA, CCS, COL
Proficient in Cotiviti, Reveleer
Proficient in Medacapture and Medabstract
Proficient in Various Epic and Cerner Modules
Proficient with McKesson, Allscripts, Soarian and Citrix
Recent experience and knowledge of HCC Coding, Risk Adjustment, Medicaid and Medicare
Familiar with Medical Billing and Coding, CPT Codes, HIPPA Compliance and Accounting
Proficient in Microsoft Office
Close Attention to Detail
Ability to work independently
Experience with speaking with Providers and Clinical Staff
Strong Communication Skills
Ability to Multitask
Strong Work Ethic
Over 5 years of Experience in Remote Work
Over 8 Years of Experience in Hospital and Outpatient Records
Type 45-50 wpm
Ability to Work off 2-3 Computers at a time
PROFESSIONAL EXPERIENCE
2014 – 2019
REMOTE HEDIS NURSE, tech center
Molina Healthcare
Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
Attends conference calls as necessary to provide information relating to clinical reviews and compliance
Successfully completes HEDIS technical specification training and testing
Successfully completes HEDIS software training and uses software correctly
Perform accurate HEDIS medical record data abstraction for all measure
Initiate member outreach and survey support.
Compile information and prepare reports for management.
Utilize findings and trends to improve efficiency as well as customer satisfaction.
Maintain HIPPA regulations for consumer privacy
Complete tasks in a timely manner.
Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
98% accuracy on my medical record review and abstraction.
Over-read 100% of outside vendor abstractions per client protocols.
2012-2014
REMOTE HEDIS NURSE, home care network
AETNA
Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
Attends conference calls as necessary to provide information relating to clinical reviews and compliance
Successfully completes HEDIS technical specification training and testing
Successfully completes HEDIS software training and uses software correctly
Perform accurate HEDIS medical record data abstraction for all measure
Initiate member outreach and survey support.
Compile information and prepare reports for management.
Utilize findings and trends to improve efficiency as well as customer satisfaction.
Maintain HIPPA regulations for consumer privacy
Complete tasks in a timely manner.
Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
98% accuracy on my medical record review and abstraction.
Over-read 100% of outside vendor abstractions per client protocols.
EDUCATION
2019 – PRESENT
ASSOCIATE OF SCIENCE IN NURSING, stark state college
2007 - 2009
LICENSE PRACTICAL NURSE, brown mackie college
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