Shanthapriya, Mani

****, ********* **** ****, *******, GA 30024

Cell: 404-***-****;

adyrux@r.postjobfree.com

Skills:

• HEDIS

• Quality Improvement projects (QIP)

• Medical Records Retrieval

• Microsoft Office Suite

• SQL(Joins,aggregate function)

• Excel(Vlookup,Pivot Tables,Conditional Formatting)

• Tableau

Professional Experience:

01/2023 – 05/2023

Quality Improvement Specialist

CENTENE Corporation (Peach State

Healthplan) Mindlance staffing -Remote

• Heavy chart monitoring and auditing of medical records

• Experience working with Different HEDIS measures

• Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management

• Formulate and prepare ad-hoc and additional reporting requirements

• Recommend, develop, and implement quality improvement plans with management

• Train providers and staff in methodologies and tools of continuous quality improvement

• Prepare for and participate in meetings with State agencies, providers, and stakeholders

• Perform audits on to meet state and internal requirements June 2021 - Dec 2022

Document Management Specialist

Change Health Care/Remx Remote

• Familiarity with HIPPA and PHI rules.

• Sort and index electronic PDF images.

• Performed Routine Data entry into ODIS Data base.

• Retrieving medical record Request remotely via

provider/facility EMR systems.

• Processing direct request from clients to receive compliant data elements for HEDIS via Client push processes.

• Use of itools Applications: WebDU, WebMD and File manager.

• Preparation of client deliverables for the CMS Risk adjustment sweep.

• Identify and remove excess information from provider supplied charts.

• Managed 80-110 charts every day.

Oct 2020 - May 2021

Customer Service Representative

Change Healthcare/ Remx Staffing

• Handle Inbound and outbound calls between providers and members to expedit the retrieval of Medical records.

• Assist Members in explaining the Insurance Benefits,Medical Claims .

• Document all activities and Metric and reporting the Management .

• Process written customer correspondence and provide the appropriate level of timely follow up.

• Handled about 50 Calls per day.

Education:

Madras University, - Chennai, Tamil Nadu - India 2001 Bachelor of Science (Major in Electrical and Electronics)

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