Data Entry Medical Records
Resume:
SSRELLE K SAIKALY, LPN
Akron, Ohio ***** · 330-***-****
**********@*****.***
PROFESSIONAL SUMMARY.
HEDIS Nurse with over 10 years of experience in workflow development as well build experience in various medical software modules. I have gained knowledge and skills in security (HIPPA), meeting the requirements of Joint Commission, document imagery, release of information and abstracting clinical data. I am qualified for the positions in my field because I exude integrity and have a proven ability to support and deliver excellent auditing to Physicians and Clinical Staff and delivering 98% accuracy on HEDIS charts.
PROFESSIONAL SKILLS
● Recent and related experience working
with HEDIS Measures ABA, WCC, CBP,
COA, MRP, CDC, PPC, CIS, LSC, IMA, CCS,
COL, EED
● Proficient in Cotiviti, Reveleer
● Proficient in Medacapture and
Medabstract
● Proficient in Various Epic and Cerner
Modules
● Proficient with McKesson, Allscripts,
Soarian and Citrix
● Recent experience and knowledge of HCC
Coding, Risk Adjustment, Medicaid and
Medicare
● Familiar with Medical Billing and Coding,
CPT Codes, HIPPA Compliance and
Accounting
● Proficient in Microsoft Office
● Close Attention to Detail
● Ability to work independently
● Experience with speaking with
Providers and Clinical Staff
● Strong Communication Skills
● Ability to Multitask
● Strong Work Ethic
● Over 5 years of Experience in Remote
Work
● Over 8 Years of Experience in Hospital
and Outpatient Records
● Type 45-50 wpm
● Ability to Work off 2-3 Computers at a
time
References Available Upon Request
PROFESSIONAL EXPERIENCE
2024-2025
CVS
HEDIS NURSE/REMOTE OVERREADER
Abstraction for all measures
Overreading for all measures
● Communication identification of pursuit leads for additional medical records, if needed, to other members of the team
● Attends conference calls as necessary to provide information relating to clinical reviews and compliance
● Successfully completes HEDIS technical specification training and testing
● Successfully completes HEDIS software training and uses software correctly
● Perform accurate HEDIS medical record data abstraction for all measure
● Initiate member outreach and survey support.
● Compile information and prepare reports for management.
● Utilize findings and trends to improve efficiency as well as customer satisfaction.
● Maintain HIPPA regulations for consumer privacy
● Complete tasks in a timely manner.
● Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
2022-2023
UNITED HEALTH CARE
HEDIS NURSE/Remote Nurse
Abstraction for all measures
Overreading for all measures
● Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
● Attends conference calls as necessary to provide information relating to clinical reviews and compliance
● Successfully completes HEDIS technical specification training and testing
● Successfully completes HEDIS software training and uses software correctly
● Perform accurate HEDIS medical record data abstraction for all measure
● Initiate member outreach and survey support.
● Compile information and prepare reports for management.
● Utilize findings and trends to improve efficiency as well as customer satisfaction.
● Maintain HIPPA regulations for consumer privacy
References Available Upon Request
● Complete tasks in a timely manner.
● Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
● 98% accuracy on my medical record review and abstraction.
● Over-read 100% of outside vendor abstractions per client protocols.
2014 – 2019
REMOTE HEDIS NURSE, TECH CENTER
MOLINA HEALTHCARE
● Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
● Attends conference calls as necessary to provide information relating to clinical reviews and compliance
● Successfully completes HEDIS technical specification training and testing
● Successfully completes HEDIS software training and uses software correctly
● Perform accurate HEDIS medical record data abstraction for all measure
● Initiate member outreach and survey support.
● Compile information and prepare reports for management.
● Utilize findings and trends to improve efficiency as well as customer satisfaction.
● Maintain HIPPA regulations for consumer privacy
● Complete tasks in a timely manner.
● Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
● 98% accuracy on my medical record review and abstraction.
● Over-read 100% of outside vendor abstractions per client protocols.
2012-2014
REMOTE HEDIS NURSE, HOME CARE NETWORK
AETNA
● Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
● Attends conference calls as necessary to provide information relating to clinical reviews and compliance
References Available Upon Request
● Successfully completes HEDIS technical specification training and testing
● Successfully completes HEDIS software training and uses software correctly
● Perform accurate HEDIS medical record data abstraction for all measure
● Initiate member outreach and survey support.
● Compile information and prepare reports for management.
● Utilize findings and trends to improve efficiency as well as customer satisfaction.
● Maintain HIPPA regulations for consumer privacy
● Complete tasks in a timely manner.
● Ensure compliance with NCQA, federal, state and another regulatory agency
Standards.
● 98% accuracy on my medical record review and abstraction.
● Over-read 100% of outside vendor abstractions per client protocols.
EDUCATION
2019 – PRESENT
ASSOCIATE OF SCIENCE IN NURSING, STARK STATE COLLEGE 2007 - 2009
LICENSE PRACTICAL NURSE, BROWN MACKIE COLLEGE
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