Medicare Advantage Program Management

Kimberly A. Sorace, LPN

*** **** ***** ******, **********, New Jersey 08876, Phone 908-***-****, *********@*******.*** Page 1 of 3

Professional Experience

• Experienced in client relations and program management

• Ability to multitask, delegate and perform in a fast-paced demanding environment

• Proven organizational and problem-solving expertise

• Success in understanding practice needs to deliver action deliverables

• Therapeutic areas COPD/CHF, Diabetes, Vascular Disease, ESRD Employment History

March 2020 to Present

Lumeris Healthcare

Market Manager, New Jersey Market

• Functioning independently, travel across assigned territory to meet with providers to discuss Lumeris tools and programs focused on improving the quality of care for Medicare Advantage Members and Commercial Payers

• Manage a team of Population Health Mangers directly working with assigned practice groups for the Hackensack Meridian Clinically Integrated Network, Hackensack Meridian Hospital, and its affiliate

• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and hospitals Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members and Commercial Payers.

• Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources

• Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs, and hospitals

• Develop comprehensive, provider-specific plans to increase their RAF performance and improve their coding Specificity

• Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data/forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract

• Consult with provider groups on gaps in documentation and coding

• Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership

June 2019- March 2020

Optum Insights, NJ

Healthcare Advocate, Risk, Quality and Network Solutions

• Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

• Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

• Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

• Provides ICD10 - HCC coding training to providers and appropriate office staff as needed

• Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

• Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices

• Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

• Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education effort

Kimberly A. Sorace, LPN

148 East Cliff Street, Somerville, New Jersey 08876, Phone 908-***-****, *********@*******.*** Page 2 of 3

11/2015 – June 2019

Partners in Care/Continuum Health Alliance, East Brunswick NJ Patient Care Coordinator/Practice Transformation Coordinator

• Primary contact lead on eight contracts (Medicare ACO, Cigna, Aetna and Aetna Medicare, Horizon commercial/Nj Health and Medicare Advantage program, United MA program) across thirty-two practices in ACO

• Work directly with Executive Director of Medicare ACO program and Director of Clinical Operations in program development, recruitment of new client on boarding, payer updates and workflow strategies

• Manage 25+ practices for clinical data/metrics and financial (Cost of Care and Utilization) outcomes per payor programs

• Create and implement program level workflows to the practices and staff

• Create maintain Practice specific KPI’s

• Collaborate with SR Management to Identify program opportunities for existing clients

• Collaborate with clinical supervisors across contracts to improve clinical outcomes and financial success

• Direct outreach to patients resulting in care plan development and maintenance based on outreach protocols

• Create and Manage program education and relevant material to both providers and staff 2001 – November 2015

Somerset Pediatric Group, Bridgewater NJ

Staff nurse, floor, and triage

• Triage patient acuity ranging from newborn to young adult

• Medication administration including allergy shots and vaccines

• Venipuncture

• Assist physician with all office procedures

• Lab testing including blood sugar, urinalysis and culture, wound cultures

• Perform flu testing

• Medication refills and supportive educational materials

• Manage medical supply orders for office

• Manage and perform all state laboratory testing for regulation controls and compliance 1998 – 2001

Orthopedic Associates of Central NJ, Edison, NJ

Surgical Coordinator and triage staff nurse

• Pre- and post-operative patient education

• Schedule operating room time and coordinate three surgeons between office hours and surgeries type and location

• Liaison between surgical equipment company and doctor

• Manage equipment needs for each surgery at each location

• DME precertification for pre- and post-patient needs including preadmission testing and medication orders and refills

• Surgery education and authorization forms for surgery

• Office procedures such as splinting, casting, cast removal

• Manage OSHA regulations for two offices, staff medical compliance nurse, PPD/Vaccine administration for staff and surgeons

1995 – 1998

Veterans Administration Hospital, Lyons NJ

Staff nurse, Multidicipanary Liasion

• Medication administration, and documentation on all patients

• Assist with all ADLs

• Dysphasia and skin ulcer/stoma care

• Interdisciplinary liaison with doctors, psychiatrists, and other specialties

• Peritoneal Dialysis, Tracheostomy and NG tube care and replacements, Foley catheters replacement and care

• Patient medication and behavior assessments daily Licensure Licensed Practical Nurse/LPN, New Jersey # 26NP04867800 Kimberly A. Sorace, LPN

148 East Cliff Street, Somerville, New Jersey 08876, Phone 908-***-****, *********@*******.*** Page 3 of 3

Education Warren County Vocational Technical School, Washington NJ Licensed Practical Nurse Program, August 1992

Wilkes University, Wilkes Barre, PA

Candidate, Bachelor of Science in Nursing, September 1990 thru 2015 Excelsior College, Albany NY

Candidate, Associate degree in nursing, 2012 thru 2015 Certifications Somerville Board of Health member, 2007- present appointment Emergency Medical Technician, December 2000

Red Cross BLS/CPR instructor 2005-2008

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