HEDIS Abstractor and Care Coordination Specialist
Resume:
Shakita Dawkins
Redford, MI *****
***************@*****.***
Professional Summary
Detail-oriented HEDIS Abstractor with 5 years of experience in medical record review and data abstraction. Proficient in utilizing electronic health record systems and adhering to NCQA HEDIS guidelines to ensure accurate and timely data collection. Committed to improving healthcare outcomes through meticulous data analysis and quality assurance. Work Experience
Care Coordinator
Centene-Detroit-MI
February 2021 to Present
• Completes an assessment/reassessment of overall member status evaluating members abilities and needs for services, at least annually.
• Reviews assessments and consult with care team members to participate in the development of the Person-Centered Plan of Service.
•Regularly review HEDIS measurementst and assist with appropriate scheduling.
• Reviews member progress as indicated in the Person-Centered Plan and makes recommendations to other treatment team members as appropriate.
• Fosters members ability to function independently.
• Develops and maintains networking and referral contacts with other community agencies, social, economic, medical and mental health services.
• Link and coordinate members with identified resources to obtain needed entitlements and services.
• Monitors member progress toward treatment goals (medical and pharmacy claims related to diagnosis)
•Review claims or supplemental claims databases for CPT, ICD-9CM diagnosis codes, and HCPCS codes.
•Completes data detailing pertinent clinical information in a timely manner.
•Complete EMR requests for Chronic conditions.
HEDIS Specialist
MedImpact-Novi, MI
December 2019 to March 2020
• Access patient charts in electronic health record (EHR) systems.
•Identify required data points, such as screenings, lab results, vaccinations, or chronic condition management details, as outlined by HEDIS measures.
• Extract specific clinical information relevant to HEDIS measures (e.g., blood pressure readings, diabetes care metrics, cancer screenings).
• Ensure accuracy and completeness of abstracted data.
• Enter abstracted data into HEDIS-specific software or databases.
•Document findings according to organizational protocols.
• Perform self-audits or participate in quality checks to ensure data accuracy and compliance with HEDIS guidelines.
•Communicate discrepancies or missing information to the appropriate team for resolution.
• Work closely with HEDIS project coordinators, team leads, and other abstractors.
•Participate in team meetings or updates regarding HEDIS timelines and progress.
• Adhere to HEDIS measure requirements, confidentiality policies (e.g., HIPAA), and project timelines.
•Ensure that all assigned charts are reviewed and completed by the deadline.
• Stay updated on changes to HEDIS measures or abstraction protocols.
•Participate in ongoing training sessions or refresher courses. Medical Biller
Mednax-Lilburn-GA
May 2017 to August 2019
• Responsible for providing account registration, obtaining patient MRN, billing and administrative support to the physician(s).
• Performed HEDIS scheduling and over reminder calls to patients.
• Complete the registration (Daily Census Report) and billing of all accounts in the OBR system.
• Monitors and tracks appropriate Billing Report(s) to ensure encounters and activities are appropriately captured.
• Gathering and verifying current demographic information by speaking with the parents or hospital.
•Obtain and update new born infant names on all registered accounts within a timely manner.
• Obtain correct Insurance/Medicaid information from parents.
• Contacting insurance companies to verify insurance data on accounts.
• Utilize Payer Search program to obtain correct insurance code information
• Supply and obtain authorization numbers as requested by the insurance companies.
• Reviews medical records to identify opportunities for improvement as it relates to charge capture, reconciliation and missed diagnosis or CPT codes and provides timely feedback to physicians and providers.
Education
Undergraduate in Oncology Data Analyst
University of Cincinnati-Main Campus
August 2024 to Present
Associate in Science (AS)
Wayne County Community College District - Detroit, MI September 2022 to January 2024
High school diploma or GED
Advanced Technology Academy
Skills
• Medical Billing
• CMS guidelines, Insurance/Benefit Verification (CHAMPS, CMS and Web Dennis,TruCare), Knowledge of HIPPA regulations and Medical Terminology, HEDIS, Pharmacy Rx Claims (6 years)
• Insurance Verification
• Medical Records
• Medicare
• Microsoft Word
• Excel
• SharePoint
• One Note
• Outlook
• Teams
• Zoom (5 years)
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