Clinical Quality Associate Director
Resume:
Roselia Rodriguez
Salem, OR *****
*******.*************@*****.***
Professional Summary
Willing to relocate to: Salem, OR - Keizer, OR - Wilsonville, OR, Woodburn, OR -Newberg, OR -Albany, OR, Corvallis, OR,
Authorized to work in the US for any employer.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Willing to relocate: Anywhere
Work Experience
Clinical Quality Analyst HEDIS
UHG Worldwide-Salem, OR
Present
providing technical expertise in HEDIS® measures, conducting quality audits, and supporting abstraction teams. Work with the Associate Director and Manager of Clinical Quality to create and implement strategies, work plans, policies and procedures and documents to maintain compliance with state and federal regulatory requirements including the Centers for Medicare & Medicaid Services, state Medicaid and NCQA accreditation standards
Ability to use applied analytics to forecast and trend retrospective and prospective HEDIS® data Design, create and implement Quality Improvement HEDIS projects and initiatives Conduct and manage outcomes of various studies that may include analyzing, reviewing, forecasting, trending, and presenting information for quality planning and management needs Provide analytical support and expertise when compiling and reporting information Develop and present recommendations and alternatives for management and executive review Assume responsibility for data integrity among various internal groups and/or between internal and external stakeholders
Lead and/or mentor associates
Assist in developing department strategic action plans including identification of objectives, goals and strategies
Develop, analyze and monitor new, routine and ad hoc reports using multiple data sources and systems Report and analyze member care quality for the development of plans and programs to support continuous quality improvement using HEDIS and other tools Volunteer
Be my eyes-Remote
July 2020 to Present
• Provide visual assistance to visually impaired individuals that are a part of the Be my eyes community.
• Take calls at random, provide verbal information about surroundings and immediate concern. Memory Care Director
Cedar Village Retirement Community-Salem, OR
April 2024 to December 2024
• Hire, train, and supervise memory care staff members
• Budget for on-site services, marketing, etc.
• Develop and update a memory care program
• Act as a role model and step in for staff
• Maintain healthy communication with residents’ families and care teams
• Educate staff and residents’ families about dementia
• Collaborate closely with activities assistants to monitor resident engagement
• Partner with community members, like the local library or senior center, to offer new engagement opportunities for residents
• Participate in ongoing dementia training along with staff
• It oversees all marketing efforts to maintain full occupancy.
• The role includes providing programs that enrich residents' lives through social interaction, entertainment, arts and crafts, physical activity, education, religious services, and community participation.
• Ensured compliance with state and federal laws, as well as company policies, concerning resident care and community operations, and maintains good relationships with state regulatory officials.
• Supervising healthcare-related programs and services, such as medication administration, bathing, staff training, and documentation, ensuring adherence to all relevant state regulations. It entails
• Directing and overseeing the accurate and timely completion of billing, accounting, and bookkeeping tasks. The role
• Supports the coordination of new resident move-ins and periodically assesses each resident's status and compliance with the Residency Agreement terms.
• managing and leading the community team, focusing on recruitment, retention, performance management, employee development, coaching, and feedback.
• Regular monitoring of kitchen sanitation, meal quality, service standards, staff cleanliness, resident apartment upkeep, and resident satisfaction.
• Implementing a quality assurance program that continuously evaluates each department's performance and maintaining a safe environment for residents. Administrator
A Golden Hand Home Care Services Inc.-Salem, OR
July 2023 to April 2024
I am responsible for supervision and management of staff including,
• Interview prospective candidates and hiring.
• Assigning, evaluating, and taking disciplinary actions.
• I direct, supervise and evaluate caregiving and office personnel and coordinate services of all team members of the multi-teamed site(s). Perform routine visits to patient homes or institutional setting and/ or participate in on-call schedule, cover shifts as needed.
• Overseeing the daily operations, running audits, ensuring that the agency follows the OHA and maintain updated records of business activity by ensuring compliance with legal regulations and guidelines. Provide additional support to employees as needed (e.g., answer phones, take messages).
• Write letters, faxes, emails etc. Answer incoming calls, emails and texts specifically directed towards leadership i.e., employment verification Act as the point of contact for internal/external clients as well as internal staff members.
Medical Assistant
Small town pediatrics-Silverton, OR
November 2022 to July 2023
• Arrange hospital admissions and laboratory services.
• Check with patients and type up their charts.
• Assist during medical examinations and procedures.
• Produce and distribute correspondence memos, letters, faxes, and forms. Prepare and clean treatment rooms and medical instruments.
• Review patients' immunization records for WCC examinations and prepare forms for provider signatures. Assist physicians and nurses with patient examinations, procedures, and treatments. Prepare examination rooms by ensuring cleanliness and stocking necessary supplies.
• Take vital signs such as blood pressure, temperature, pulse rate, and respiratory rate accurately.
• Administer medications under the direction of healthcare professionals.
• Perform basic laboratory tests, including specimen collection and routine tests.
• Manage patient medical records by accurately documenting information in electronic health record systems.
• Schedule appointments for patients, coordinating with other departments as needed.
• Provide exceptional customer service to patients by addressing inquiries and concerns promptly and professionally.
• Educate patients on medication instructions, post-treatment care, and preventive measures.
• Assist with minor surgical procedures by preparing sterile equipment and assisting during the procedure.
• Monitor inventory levels of vaccines or medications requiring special storage conditions closely.
• Contribute to a positive work environment through effective communication with colleagues.
• Ensure compliance with HIPAA regulations regarding patient privacy and confidentiality at all times.
• Maintain inventory of medical supplies and equipment to ensure availability when needed.
• Demonstrate proficiency in using electronic health record (EHR) systems. Medical Assistant
Falls Canyon Surgical-Silverton, OR
June 2022 to November 2022
• Assisted in patient examinations, procedures, and treatments.
• Prepared examination rooms by ensuring cleanliness and stocking necessary supplies.
• Took vital signs such as blood pressure, temperature, pulse rate, and respiratory rate accurately.
• Administered medications under the direction of healthcare professionals.
• Performed basic laboratory tests including collecting specimens and conducting routine tests.
• Managed patient medical records by accurately documenting information in electronic health record systems.
• Scheduled appointments for patients, coordinating with other departments as needed.
• Provided exceptional customer service to patients by addressing inquiries and concerns promptly and professionally.
• Educated patients on medication instructions, post-treatment care, and preventive measures.
• Maintained a clean and organized work area to ensure safety and efficiency in daily operations.
• Demonstrated proficiency in using electronic health record (EHR) systems for accurate documentation and retrieval of patient information.
• Served as a liaison between patients/families and healthcare providers to facilitate smooth communication flow.
• Responded quickly during emergencies or urgent situations within the clinic setting.
• Closely monitored inventory levels of vaccines or medications requiring special storage conditions.
• Assisted with administrative tasks such as filing documents or processing paperwork.
• Contributed to a positive work environment through effective communication with colleagues.
• Aided in training new medical assistants on office protocols and clinical procedures.
• Participated in staff meetings to discuss updates on policies, procedures, or changes in healthcare regulations.
• Ensured compliance with HIPAA regulations regarding patient privacy and confidentiality at all times.
• Supported front desk operations by greeting patients, checking them in/out, and managing phone calls efficiently.
• Coordinated referrals to specialists or other healthcare providers based on physician recommendations.
• Collaborated with insurance companies to verify coverage eligibility for patients' medical services.
• Assisted with minor surgical procedures by preparing sterile equipment and assisting during the procedure itself.
• Maintained inventory of medical supplies and equipment to ensure availability when needed. Medical Records Technician
Allymar Health Solutions-Salem, OR
March 2022 to June 2022
Traveled to and from Provider Office locations to carry out document:
• sorting
• preparation
• scanning
• downloading
• uploading
• Record
• track patients' medical histories, test results, and treatment plans.
• organizes patient records and identifies data within these files that are pertinent to HEDIS measures
• Utilize a provided list to retrieve records—either through physical scanning or digital downloading from a multitude of EMR systems on a daily basis
• upload the digitized records via a secure upload portal. Spanish Medical Interpreter
CulturaLink-Salem, OR
January 2022 to March 2022
• Provide remote interpreting services for individuals with language barriers.
• Facilitate communication between parties who do not speak the same language.
• Connect with clients via video platform and ensure quality of service.
• Monitor video and audio connections to ensure smooth communication.
• Interpret conversations accurately and in a timely manner.
• Research unfamiliar words, phrases, and terminology to ensure accurate interpretation.
• Provide technical support to clients who are having difficulties with the video platform.
• Maintain a professional attitude and demeanor during all video sessions.
• Follow protocols and guidelines set by the company and clients.
• Remain current on industry trends, best practices, and technology. Remote National Certified Medical Assistant
Mohammad Rezvani M.D.-Culver City, CA
April 2021 to January 2022
Answer phones and scheduled appointments
Verify insurance eligibility and benefits prior to visit. Submit prior authorizations to insurance companies for medications, durable medical equipment, as well referrals for services with outside providers and/or specialist. Scheduled follow up appointments. Reached out to managed health care provider to switch providers per patient request. Checked patients in/out virtually.
Medical Assistant/Administrative Assistant
ADVANCED FOOT CLINIC-Salem, OR
December 2019 to April 2021
• Assisting with patient preparation, routine foot care procedures, and post-visit care.
• Managing appointment scheduling and record keeping.
• Scan/electronically file medical records
• Providing patient education on foot care practices.
• Performing pretreatment foot exams.
• Applying casts and bandages.
• Assisting with minor surgical procedures.
• Collecting patient health information.
• Ordering, sorting, and storing supplies.
• Restocking exam rooms.
• Cleaning exam areas and setting up instruments and equipment
• Check in patients and collect co-payments
• Answered multiple phone lines
• Medical Interpreter as needed.
Caregiver
ComForCare-Salem, OR
September 2019 to December 2019
Assisting with personal care, which may include:
• bathroom functions
• bathing
• grooming,
• dressing
• eating
• Following a prescribed healthcare plan, which may include assisting with exercise and administering medication.
• Ensuring the client's home is organized according to their needs and that safety measures are in place.
• You may also be expected to assist with some light housework.
• Providing emotional support and encouragement to perform necessary tasks.
• Providing mobility assistance may be required, for example helping the client in and out of bed, a chair, or a wheelchair.
• Transporting or escorting the client to medical and other appointments.
• Monitoring and reporting changes in health,behavior, and needs. Advanced Medical Support Assistant Mental Health
Veterans Health Administration-Salem, OR
December 2014 to September 2019
I performed a variety of administrative functions across multiple service lines including Medicine, Patient Care Services, Behavioral Health, Community-Based Care, Critical Care, Emergency Medicine, Primary Care, Surgery, Compensation/Pension/Occupational Health, Health Administration, Imaging, and Physical Medicine and Rehabilitation. My role in these fast-paced environments involved processing emergency, walk-in, and admission patients. Daily tasks required the use of PC applications and various veterans' health administration programs. My responsibilities included:
• Initial submission of employee timesheets.
• Scheduling, canceling, and rescheduling patient appointments and consults.
• Entering no-show information.
• Monitoring the electronic waitlist.
• Preparing for clinic visits.
• Monitoring both inpatient and outpatient appointments for areas of responsibility.
• Ensuring encounter forms are completed to obtain appropriate workload credit.
• Verifying and updating demographics and insurance information.
• Processing all emergency and non-emergency transfers to other VA facilities or private hospitals.
• Performing basic eligibility checks, co-pays, and preauthorization requirements for specific coverages, such as TRICARE and sharing agreements.
As a Medical Support Assistant in Ophthalmology, Optometry, Audiology, and Physical Therapy at the Veteran's Health Administration in Salem, OR, from December 2014 to June 2017, I was responsible for:
• Scheduling appointments in line with VHA National Scheduling Guidelines, which included interpreting and verifying provider orders, as well as scheduling, canceling, and rescheduling patient appointments and consults.
• Developing and maintaining effective communication with patients and the interdisciplinary team, including secure messaging with patients.
• Participating in team meetings to manage and plan patient care.
• Setting deadlines and priorities.
Compensation Examiner
State of Oregon Department of Justice-Salem, OR
July 2014 to December 2014
As a Claims Examiner, I worked both independently and collaboratively to assess applicants' eligibility for the Oregon Crime Victims' Compensation Program, adhering to state and federal guidelines. I was tasked with making award decisions and could authorize compensation up to $47,000 per claim. Claims Examiners also engage in training, outreach, and communication with clients, service providers, victim advocates, and criminal justice professionals. The Compensation Section processes over 7,000 claims annually from crime victims in Oregon, providing financial assistance for losses and expenses incurred from personal crimes. The CVSD allocates over $6 million every two years to cover compensation claims filed by victims, as well as sexual assault forensic medical exams and child abuse medical assessments.
• Reviewing claim documents
• Determining the appropriateness of compensation
• Finalizing the compensation amount
• Authorizing payment
• Ensuring claims adhere to laws and guidelines
National Certified Medical Assistant/Medical Interpreter Salem Gastroentorology-Salem, OR
February 2011 to July 2014
• Roomed patients took vitals, medications and record in patients chart
• Provide foreign language interpreting to enable understanding and successful communication between individuals with limited English proficiency (LEP) and providers and staff.
• Provide sight translation of English or other language documents as required.
• Adheres to interpreter standards of practice and code of ethics.
• Provide education to individuals and provider/staff on culturally specific values, beliefs, and practices that are relevant to the encounter.
• Relay concepts and ideas between languages.
• Thoroughly understand the subject matter to effectively convert source language to target language.
• Remain sensitive to the cultures associated with the languages of expertise.
• Reviewed patients record and schedule accordingly.
• Serifed insurance eligibility
• Reviewed estimates and set up payment plans • Assisted with any all-bookkeeping questions. ADHD Coordinator/Health Information
Woodburn Pediatric Clinic-Woodburn, OR
July 2005 to February 2011
• Prepared charts for upcoming ADHD/Autism evaluations by distributing Vanderbilt rating scales to schoolteachers and counselors for completion and return, in anticipation of the patient's initial appointment.
• Routinely dispatched forms to schools, counselors, parents, and any adult involved in the patient's care.
• Retrieved charts the day before to prepare for the following day's clinic appointments.
• Accessed charts as necessary to fulfill medical records requests, while complying with all HIPAA regulations.
• Translated documents and provided interpretation services as required. Addressed requests from law offices, DHS, and other entities as needed.
Education
Associate in Business Management
Community College of the AirForce - Montgomery, AL April 2012 to April 2013
Associate's degree in Business Management
American InterContinental University-Online - Chandler, AZ September 2009 to June 2011
High school diploma in Business Management
Mckay High School - Salem, OR
September 1998 to June 2001
Skills
• Medical receptionist
• Microsoft Word
• Experience Administering Injections
• Epic (7 years)
• Multi-line phone systems
• Microsoft Outlook (10+ years)
• Medical office experience
• Front desk
• Databases
• Leadership
• Customer Service
• Data entry
• Home Care
• Windows
• Care plans
• Microsoft Excel
• Physiology knowledge
• Insurance Verification
• Personal Care
• Typing
• CPRS (5 years)
• Process improvement
• EMR Systems
• Scripting (10+ years)
• CPT coding
• Microsoft Word (10+ years)
• Spanish
• Laboratory procedures
• Direct Care
• Time management
• Administrative experience
• Anatomy Knowledge
• Medical Records
• Ophthalmology Experience
• Primary Care Experience
• Microsoft Powerpoint
• Triage
• Phone Etiquette
• Patient Care
• Time & Attendance Systems (3 years)
• Medical Scheduling
• Computer literacy
• Intake
• HIPAA
• Care Giver
• Home Health
• Medical terminology
• Clerical experience
• Communication skills
• Office Management
• Documentation review
• Vital Signs
• Medical Billing
• Phone triage
• Medical Terminology (10+ years)
• Office Experience
• Employee Orientation
• Analysis skills
• English
• Next Generation Sequencing (7 years)
• Medication Administration (3 years)
• Interpretation
• Translation
• Caregiving
• Filing
• Nursing
• Behavioral Health
• Medical documentation
• EMR systems
• Microsoft Office (10+ years)
• Customer service
• Athenahealth
• Expert
Languages
• Spanish - Fluent
Military Service
Branch: United States Army
Service Country: United States
Rank: Specialist
June 2000 to January 2005
92G
Certifications and Licenses
Certified Medical Assistant
Certified Administrative Professional
CPR Certification
BLS Certification
NCMA
Driver's License
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