SSRELLE K SAIKALY, LPN

Akron, Ohio ***** · 330-***-****

adxau6@r.postjobfree.com

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

Contact this candidate