Quality Improvement Specialists
Resume:
VICKIE
JENKINS
PROFESSIONAL SUMMARY
A disciplined medical billing and coding professional bringing 30+ years of industry expertise and excellence in insurance verification and claims processing, prior authorization, and patient services to champion case and utilization management for companies. Possesses deep knowledge of medical terminology, human resources information tools, data management, and HIPAA/OSHA compliance—while specializing in superior patient engagement and multi-tier research to drive quality and ensure customer success. SKILLS
Troubleshooting, Communication, Team Building, Technical Writing, Medical Terminology, Project Management, Customer Service, Mentoring, Data Entry, Accuracy, Cash Management, Patient Services, Audits, Process Improvement, Computer Literacy, Presentations
EXPERTISE
Medical Billing, Insurance Claims Processing, Medicare, Medicaid, Training, Research, Medical Insurance, Payroll Software, Medical Coding, HIPAA, OSHA, Prior Authorization, Insurance Verification
& Eligibility, Provider Relations, Relationship Development, Quality Assurance
PROFESSIONAL EXPERIENCE
Health Choice Utah—Murray, UT 03/2021-present
Quality Improvement Specialists
Acts as a facilitator and consultant for Health Plans quality improvement initiatives, providing expert input regarding problem identification and resolution, continuous quality improvement, process mapping and redesign, and regulatory requirements.
Partners with leadership, providers and staff to design and implement strategies for identified quality improvement opportunities.
Facilitates communication and collaboration across providers and the continuum. Collaborates with leaders, departments, committees, and individuals to support the Health Plans mission and strategic goals.
Performs audits, chart reviews, and prepares reports to assess and improve Health Plan compliance with HEDIS measures, operational goals, State Medicaid, and CMS requirements.
Reviews and interprets patient care information, from the medical record and other data sources used to identify quality of care issues. Transforms these facts into actionable information for improvement work.
Provides education to the organization regarding quality and patient safety topics, performance improvement, and other regulatory metrics and standards.
Provides technical assistance to providers in quality assessment, monitoring, and improvement. Develops collaborative projects and works with care management teams, a variety of public and private providers, policymakers, and researchers to facilitate improvement in population health.
Aetna (CVS) – Sandy, UT
Network Relations Consultant 10/2017-01/2021
Facilitated streamlined management of all new contracts and existing amendments for individual providers across each contract, implementing 2-week audits for new contracts, reviewing claims histories, and negotiating rates with provider groups as needed.
Recognized as the subject matter expert regarding network issues and product contracts, researching all support requests and creating each new product contract across Utah, Wyoming, and Montana. University of Utah Health Plans – Salt Lake City, UT Provider Relations Contracting Coordinator 08/2014-09/2017
Administered effective quality control across new contract (and existing amendment) management, ensuring implementation of 90- day audits for new contracts, review of claims history, and creation of JIRA tickets to guarantee correction of any errors in payments to the provider.
Provided strong communication between providers and internal customer service teams to market health plan products to clients, provide personal support to account executives, and drive database entry accuracy and client-base strategy development.
9704 South Wood Ranch Drive, South Jordan, UT 84009
**********@*****.***
linkedin.com/in/vickie-jenkins-343a0414/
Lead Case Management Coordinator 11/2005-08/2014
Supplied strong leadership and management of information for individual patient cases, developing and maintaining strong relationships between hospital administration, medical vendors, patient-care providers, and billing departments to optimize patient care and ensure recordkeeping accuracy.
Drove alignment with organizational requirements and standard operating procedures by successfully training and mentoring new hires, overseeing staff payroll administration, and effectively providing support to Medicaid members regarding benefits and regulations.
Supervised 6 case management coordinators to ensure completion of daily operational tasks within assigned deadlines. ADDITIONAL EXPERIENCE
Health Information Technician – University of Utah Health Medical Center (Salt Lake City, UT) 2004-2005 Account Manager, Collections – Discover Financial Services (Salt Lake City, UT) 2003-2004 Security Officer – Discover Financial Services (Salt Lake City, UT) 2002-2003 Card Member Services – Discover Financial Services (Salt Lake City, UT) 2000-2002 EDUCATION, CERTIFICATIONS & ADDITIONAL CREDENTIALS Bachelor of Business Management, University of Phoenix Associates of Computer Networking, Steven Henagar College Word Processing & Data Entry Certification, Butte Vocational Technology Additional Skills: Microsoft Office Suite, Accounting Software, Salesforce, Oracle, QuickBooks, AS400, HRIS Software, ADP, Workday, Treehouse, Talent Hub, File Sharing Software, Google Suite, Epic, Strategic Contract Manager, ASD NextGen HRP Platform, C+, Linux, Epic, MHK, MedMC, Care Radius, Change Healthcare, NCQA. REFERENCES: AVAILABLE APON REQUEST
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