Medical Records Quality Assurance
Resume:
Paula Hromek
Coxsackie, NY *****
**********@************.*******.***
Work Experience
HEDIS Reviewer/Abstractor
TotalMed
January 2024 to May 2024
• Collect member records
• Conduct reviews of these records, placing the results collected into a specific data base.
• Performs quality assurance on data abstracted from medical records.
• Reviewing and comparing data abstracted from medical records with the appropriate measure guidelines.
• Researching any discrepancies found by reviewing medical records, claims data and any other relevant information.
• Identifying trends and documenting any errors found.
• Applying structured auditing criteria to medical records to determine compliance with HEDIS standards.
• Demonstrating expertise in the requirements and parameters of mandated HEDIS performance measures.
• Maintaining productivity levels as determined by the Quality Improvement Department.
• Accurately entering the results of chart audits into a database.
• Monitoring progress towards completion of the annual HEDIS chart abstraction process
• Utilizing various software applications to support HEDIS operations Hedis Reviewer/Auditor
eTeam Inc-Remote
January 2023 to May 2023
• Data collection from provider offices and abstraction of those records utilizing NCQA HEDIS Technical specifications
• Medical record review
• abstraction from electronic medical records
• Locate and review all assigned medical charts and perform abstraction of charts sent in by providers.
• Perform complete and accurate review of qualifying services and results into HEDIS electronic database software and other duties as assigned
• Demonstrate ability to successfully prioritize and organize a high volume of work to meet deadline
• Attend weekly and as needed department meetings
Hedis Reviewer/auditor
Medasource-Remote
June 2022 to September 2022
Analyze medical records created within the environment and upon review, determine if they are duplicates.
Insure a smooth consolidation of the medical records under review. Audit, examines, verifies, adjusts, and corrects medical records. COVID-19 Screener/Swabber
Adecco-BioReference Laboratories-Albany, NY
April 2021 to July 2021
HEDIS Reviewer/Abstractor
TotalMed-Remote
January 2021 to April 2021
• Collect member records
• Conduct reviews of these records, placing the results collected into a specific data base.
• Performs quality assurance on data abstracted from medical records.
• Reviewing and comparing data abstracted from medical records with the appropriate measure guidelines.
• Researching any discrepancies found by reviewing medical records, claims data and any other relevant information.
• Identifying trends and documenting any errors found.
• Applying structured auditing criteria to medical records to determine compliance with HEDIS standards.
• Demonstrating expertise in the requirements and parameters of mandated HEDIS performance measures.
• Maintaining productivity levels as determined by the Quality Improvement Department.
• Accurately entering the results of chart audits into a database.
• Monitoring progress towards completion of the annual HEDIS chart abstraction process
• Utilizing various software applications to support HEDIS operations. Medical Assistant/Surgical Technician
TLC Laser Eye Centers-Slingerlands, NY
October 2017 to February 2019
Escort patients in a timely fashion
Documentation of patient medical history in EMR
Assists physician in Lasik/PRK Laser procedures
Prepares sterile treatment fields
Order and maintain clinical supplies and equipment Consenting patients on procedures
Medical Assistant
The Urological Institute of NENY-Albany, NY
November 2014 to May 2017
Escort patients in a timely fashion
Prepare patients for Cystoscopies, Biopsies and Vasectomies Assist physician(s) in urologic procedures
Obtained vitals
Documentation of patient medical history in EMR/EHR system Order and maintain clinical supplies and equipment Consenting patients on surgeries/procedures
Ensuring exam rooms are clean, fully stocked, and prepared for visit Schedule appointments and surgeries
Obtain prior-authorizations
Medical Assistant
Hudson Valley Foot Associates-Kingston, NY
January 2011 to November 2015
Escort patients in a timely fashion
Prepares patients for examinations and treatment
Maintaining timely patient flow
Documentation of patient medical history in EMR/EHR system Order and maintain clinical supplies and equipment Fit post-op patients with proper braces
Travel to satellite offices w/physician(s)
Responsible for the daily flow of satellite offices Check in/check out patients
Obtain prior authorizations
Verify insurance coverage
Medical Assistant/Medical Secretary
Capital Region Orthopaedic Group-Albany, NY
January 2000 to July 2009
Responsible for all incoming calls for physician(s) Scheduling of surgeries/procedures
Obtain prior-authorizations
Consenting for upcoming surgeries
Escort patients in a timely fashion
Documentation of medical history in EMR/EHR system Prepares patients for examinations and treatment
Assist physician(s) in procedures
Apply/removal of casts
Ensuring exam rooms are clean, fully stocked, and prepared for visit Medical Assistant/ Medical Secretary
St. Lawrence Urology-Potsdam, NY
April 1996 to January 2000
Assist physician in urological procedures
Perform bladder scans
Scheduling of surgeries
Order lab work and tests
Obtain insurance prior-authorizations
Responsible for ordering clinical supplies
Travel to offsite offices with physicians
Education
St. Lawrence Tech. - Ogdensburg, NY
February 1997 to August 1997
High school diploma
Coxsackie-Athens High School - Coxsackie, NY
September 1986 to June 1992
Skills
• Medical Records
• Microsoft Excel
• Epic
• Microsoft Word
• EMR
• HEDIS
• NCQA Standards
• Patient Care
• Data collection
• Scheduling
• Time management
• HIPAA
• Documentation review
• Communication skills
• CMA
• Auditing
• Insurance Verification
Certifications and Licenses
Certified Medical Assistant
CPR Certification
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