Medical Records Data Entry

Letitia Clark

*** **** ***** ******* **** IL ****9

Phone 702-***-****

Email: *************@*****.***

Objective I am a highly motivated professional with superior customer service. I have over 38 years of extensive administrative experience in the healthcare industry. Ranging from hospitals ER and Trauma Centers to Corporate Offices working with Managed Care Organizations and Commercial Insurances. My personal goal is to become a member of an organization which offers growth and opportunity where my interpersonal and communicative skills can be utilized effectively.

Skills

Organizational Skills

Customer Relation Skills

Electronic Filing

Microsoft Word

MS Excel/Outlook

Medical Terminology

Medi-Tech Software

Soarian Medical Software

Data Entry

Knowledge of HEDIS Measures

Fax/Copier/Scan

Windows Software 7,8,10

MS Power Point

Typing 45-55 WPM

Epic Live Med-Software

Ecare Insurance Eligibility

ICD 9 & 10/CPT Codes

Ciox/NCQA/HIPPA

Knowledge of Medical Terminology

Experience

Multiple Contract Assignments

Reason for any gaps looking for work and/or taking care of ailing family member.

QI Specialist 04/2024 to 07/2024

Pyramid Consultant Full-Time 40hr/wk

Centene Corporation

Support the development and maintenance of quality improvement-related projects and reporting. Respond to quality improvement inquiries.

Requests and gathers medical Records for extraction for HEDIS Hybrid Audit

Contact providers to follow up on Medical Records Requests

Actively participate in understanding and addressing HEDIS Hybrid needs

Requests and completes medical records requests assigned

Accurate time reporting and assist other team members as needed

Ability to adjust to changing circumstances

HEDIS Abstractor/Reviewer 01/2023 to 05/2023

SGS Consulting Agency Full-Time 40hr/wk

CVS Health Inc.

Abstract and review medical records for CVS Health members.

Encompass Medical Records to review, including data collection from provider offices and abstract those records utilizing NCQA HEDIS technical specifications.

MRR also abstract medical records from electronic medical records and/or abstraction from Faxed/Mailed Medical Records

Locate and Review all assigned Medical Charts and perform abstraction of charts sent in by providers.

Conduct Non-Responder calls to provider offices to request Medical Records.

Perform complete and accurate review of qualifying services and results into HEDIS electronic database software and other duties as assigned

HEDIS Abstractor/Reviewer 12/2020 to 04/2022

Healthcare Support (Agency) Full-Time 40hr/wk

Anthem Healthcare, Indianapolis IN

Coordinate and abstract medical records for Anthem members

I was assigned to six different states where I was to pull HEDIS Measures from different EMR sites and upload to main data spreadsheet Reveleer, Cotiviti, and QRIS.

I was assigned a list with productivity at minimum 75-100 charts pulled per day.

Attended daily/weekly team meetings for daily changes and updates.

Researched information for problem solving issues thru.

Worked with HEDIS measures to identify the information and requirements to show adherence of required measure.

Escalate work related issues to assigned Lead HEDIS Reviewer/Nurse

Responsible for ongoing data collection, abstraction, data entry and performance improvement.

Maintain provider outreach to support HEDIS and MRR projects to include but not limited to: Validation of fax numbers, provider office locations, HEDIS contact information, scheduling of onsite retrieval appointments; maintenance and follow-up for pull lists and investigation into further needed documentation.

Medical Record Clerk 02/2020 to 10/2020

Robert Half/Office Team (Agency) Full-Time 40hr/wk

Roseland Community Hospital, Chicago IL

Provide and assist with coordination of medical record

Purging medical records

File laboratory, X-ray documents, slips and other information to current chart

Supply nursing staff with required forms and documents

Maintain data collection and skills acquisition files

Protect medical records from loss or defacement prior to the end of retention periods

Maintain face sheets for every patient

Process admission and discharge records accurately, and in a timely fashion

Abstract patient’s health records and assign alpha-numeric codes for each diagnosis and procedure

Maintain strict confidentiality of all medical records

**Cared for my ailing parent between June 2018 through February 2020**

HEDIS Abstractor Coordinator 03/2018 to 06/2018

Centene Corporation (Envolve), Full-Time 40hr/wk

Chicago IL

Coordinate and abstract medical records for MCO members

Telephonic outreach involving medical case management

Receives incoming requests for information and responds to requests by validation of fax numbers, provide maintenance and follow-up for pull lists

Review and validate all requests and authorizations for release of medical information according to established procedures and HIPAA guidelines.

File copy company invoices, print pull list from MRR tool and same to plan drive

Pull incoming medical records from the fax and copy queues and save to the appropriate plan drive in the designated measurement folders

Scanned documents into folders thru the electronic HEDIS database (QSHR)

Support quality improvement programs and studies by requesting records from providers, maintaining databases, and researching health plan encounter data on an ongoing basis.

Work on designated projects assigned and deemed as necessary

Health Coordinator 08/2017 to 03/2018

Maxim Healthcare Staffing Full-Time 40hr/wk

Blue Cross Blue Shields, Chicago IL

Primary lesion between Members and Care Coordinators

Organized outreach to members to educate about medical programs and develop programs to meet the educational needs of members

Conducted research and performed data entry while responding to inquiries from BCBS members

Supported clinicians in the Medical Management Department with providers and member enrichment activities

Assist with calling BCBS members to complete HRA/HRS assessments

Provider Service Representative 11/2016 to 04/2017

Total Med Healthcare (Agency) Full-Time 40hr/wk

Aetna Better Health, Chicago IL

Provide and assist with coordination of MCO Medicaid Insurance and responsible for developing and maintain a cooperative working relationship with the contraction provider community.

Coordinated and delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid and MCO’s

Facilitated data collection between state Medicaid and MCO’s

Educate and researched problems to assist the provider concerns

Logged inquiries and disputes/Client disputes

Prioritized dispute letters and communication for denied claims

Identify and evaluate contractual financial requirements

HEDIS Abstractor Coordinator 03/2016 to 06/2016

Maxim Healthcare Services (Agency) Full-Time 40hr/wk

Blue Cross Blue Shields, Chicago IL

Coordinate and abstract medical records for Medicaid Members

Complied with HIPPA, NCQA, Diversity Principles, Corporate Integrity, Compliance program policies and other applicable corporate and department policies

Responsible for coordinating and supporting the HEDIS and QRS medical record submission process

Assist with visiting assigned medical facilities to retrieve, abstract, and scan HEDIS measures into the QSHR database

Request and retrieved medical records thru CIOX health

Request medical data from healthcare facilities and validate HEDIS and QRS hybrid for medical records review

Program Coordinator 10/2015 to 03/2016

Maxim Healthcare Services (Agency) Full-Time 40hr/wk

Centene Corporation, Chicago IL

Performed initial assessments for health risk screening (HRS) and refer the member to the necessary clinical staff

Managed and maintained the non-emergency medical transportation account for eligible members

Maintain the integrity of PHI

Maintain working relationships with other departments

Research claims inquiry specific to the department and responsibility

Perform tasks necessary to promote member compliance such as verifying appointments and obtaining lab results

Monitored patients for eligibility and benefits

Identify members without a PCP and refer to Member Services

Screen members by priority for CM assessments

Coordinates services with community-based organizations

Call members to assure they follow up with their PCP from ER and inpatient discharges

ER Admitting Clerk 04/2014 to 04/2015

South Shore Hospital, Chicago IL Full-Time 40hr/wk

Designed and developed office operations and procedures to meet patient and physician needs

Facilitated and participated in the orientation/training of staff employees

Pre-registered clients for outpatient surgeries and tests

Admit patients from the emergency room and direct admits

Familiar with ICD 9 and 10 coding lookups

Call for authorizations and verifications of insurance coverage and benefits

Rescheduled outpatient appointments ran daily reports

Unit Coordinator (Medical Surgery) 04/2011 to 08/2013

Franciscan St. James Hospital, Olympia Fields IL Full-Time 40hr/wk

Represented the company in a professional and businesslike manner

Handle all typing memos assignments for the staff and unit physicians

Designed filing systems

Review office supply requisitions

Sort billing and coding reports

Maintained computerized inventory for office supplies

Transferred, admit, and discharged patients for the unit

Place patients in assigned beds

Answer and transferred all calls for the unit

Ran daily reports for physicians

Cared for an ailing family member between 2007 through 2008

Education George Washington Carver High 09/1982 to 06/1986

(Diploma Received)

Community College of Southern NV 08/2007 to 05/2010

(Paralegal Associate Degree Program)

Certificates of Achievements: Leadership Academy and Professional

Development Program

References Given Upon Request

Contact this candidate