HEDIS Auditor
Resume:
Liat Shuly
Dallas, TX *****
*********@*****.***
Proficient in medical record review & data abstraction. Dedicated to ensuring accurate and timely reporting of HEDIS measures to improve healthcare quality. Responsible for all data submitted to and pass all audits with different health plans.
Innovative, Highly motivated rounded-skills 12 years of Management/Analytic experience of which 5 years of these in the Medical Industry.
Excellent interpersonal, communication, organizational and timing management skills, Adept at teamwork, self-management and multitasking.
Authorized to work in the US for any employer
Education and Certifications:
Diploma in Medical Coding and Billing Specialist U.S. Career Institute - University of Colorado
2012 to 2013
Completed 2 years in Mass Communication Haifa University, Israel
2001 to 2003
HEDIS Abstractor Certification Care National/Kim Williams CPHQ - Remote 2019
Professional Experience
Lead HEDIS Analyst
MEDPOINT MANAGEMENT - Woodland Hills, CA
July 2017 to Nov 2020
• Coordinates client HEDIS audit management requirements (Roadmap, monitoring HEDIS timelines, audit review, medical record review validation, etc.)
• Coordinates medical record review projects including provider data cleaning, chase management, monitor quality, and rate performance, and post HEDIS analytics. Develops and improves workflows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality.
• Identifies and/or analyzes business problems and devise procedures for solutions to the problems.
• Effectively leads projects in order to produce desired results.
• Responsible for corporate communication of project results.
• Recommends and assists with implementing standard policies and procedures.
• Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis.
• Participates in development of procedures/controls and provides recommendations for the ongoing improvement of the updated process.
• Assists personnel (both internal and external) by answering questions, supplying information, and training.
• Develops and maintains an effective working relationship with customers • Participates in group or committee discussions.
• Develops documentation, reports, and presentations for all levels within the organization including executive leadership.
• Collaborates with Subject Matter Experts to develop accurate documents.
• Completes ad hoc data requests as assigned. Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions.
• Coordinates projects and analysis for management and team.
• Ensures complete, accurate, and timely data for reporting purposes.
• Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
• Built strong relationships with the different Health Plans Quality Team/Supplemental Data divisions
• Encounter data submission
Dental Office Manager
Woodland Hills Dental Group - Woodland Hills, CA
March 2016 to July 2017
• • Knowledge of HEDIS specifications and process.
Skills:
• Strong knowledge of HEDIS measures, guidelines, and abstraction methodology
• Proficient in medical terminology and coding systems (CPT, ICD-10, HCPCS)
• Excellent attention to detail and data accuracy
• Analytical and problem-solving skills
• Strong organizational and time management skills
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint)
• Ability to work independently and collaboratively as part of a team
References: Available upon request from multiple Health Plan’s Quality Improvement key managers such as Molina, Heath Net, CA-LACare, and more whom I’ve developed healthy strong relationships with
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