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Project Manager Customer Service

United States
August 14, 2012

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***** ********** ** **********, ** 30005 Phone: 770-***-****

Quality Improvement Project Manager

Lead abstraction and operation teams to more than 6 successful HEDIS and Risk Adjustment season as a Project Manager, experience included but not limited to staffing, training, auditing and managing Field and Remote Abstractors. Assist in the development of operational departments that address the project scope of work and reporting progression of the project to the health plans (Clients includes; WellCare, United HealthCare, Medica HealthCare, UCare, Regence, Blue Cross Blue Shield and Health Springs) and internal corporate governance. Expert in the usage of Certified HEDIS software that addresses the entire Medical Records Review (MRR) process. Never failed a Convenience Sample or a Medical Records Review Validation Audit (MRRV) and Inter-Rater Reliability (IRR) scores for remote and field abstractors never fell below 97% for the past 6 HEDIS season. Assist in creating focus operational teams that drives other programs such as CAHPS/CHIP, HOS, RADV, and provider/member outreach programs.

Professional Experience


HEDIS Project Manager

Key Results:

The past two HEDIS seasons I successfully driven a team of 42 Field Abstractors (RNs,LPNs, Certified Coders) that completed about eighty two thousand (82k) medical record reviews in the states of Florida, Minnesota, and Georgia that credence to about 2.8 million dollars of the company’s revenue.

Assist in drawing out information needed from the HEDIS Technical Specification regarding the measurement criteria and developing a Training Manual and PowerPoint Presentation that is concise to the intent of each measure for the Auditors, and Field/Remote Abstractors.

Organized and performed week long training in four cities for Auditors and Field/Remote Abstractors, and clients (UCare of MN, BCBS of MN and United Health Group of GA/FL) that covers the HEDIS measures, abstraction processes and project guidelines.

Planned, controlled and monitored project progression, key constraints and risk factors for the duration of the project. Along with updating the clients and internal senior management on a weekly basis using customize metric data that displays scheduling progress, work in progress, completion rate and pending issues.

Created, produced, and executed strategic analysis processes for project success in the form of implementing smaller operational teams to focus on key task that assure contractual deadlines were being met.

Assist health plans in developing rate improvement methodologies that focus in on measures that are either dramatically lagging behind or close to meeting goal.


HEDIS/Risk Adjustment Project Manager

Key Results:

Acted as a liaison between the client (Effective Health Plan…e.g. WellCare, Blue Cross Blue Shield, United Health Plan etc and company’s operation, assuring the contractual obligation between both parties are executed successfully.

Simultaneously and effectively managed both HEDIS and Risk Adjustment programs for the health plan that met/exceed internal and external goals for both programs

Create and generate customize reports for project forecasting, planning and monitoring for internal and external usage.

Advise operations of health plan’s risk factors that may negatively affect return on investment ROI for both parties.

Assist legal and finance department with making sure scope of work (SOW) reflects what both parties agreed upon.

Consult to upper management and client regarding all revenue linkage that may occur during production for a particular project.

Support/Host internal and external meetings regarding the progress of operations.


2006 to 2007


Key Results:

Mentored, interviewed and trained new recruiters

Produced and formulate strategies with Recruitment Manager that allowed effective hiring and retention of field reviewers.

Identify potential hires from several employment websites to create work list for recruitment team

Nationwide recruitment of RN, LPN, BSN, and Clinical Coders as mandated by the company project specifications

Verified Coders and Nurses credentials and update information to make it visible for the rest of the organization


Webber International University

Bachelors of Science in Business Administration and Finance

Areas of Strength

• Exemplary interpersonal and customer service skills

• Excellent oral and written communication skills; ability to think analytically and the ability to clearly communicate directly to decision makers

• Ability to work independently as well as in team environments by promoting communications and cooperation among staff, peers, superiors and customers

• Ability to assist with the completion of “HEDIS ROADMAP”.

• Ability to conform to rapidly shifting priorities, demands and timelines

• Ability to develop expertise in a variety of business concepts, practices and procedures

• Ability to create reports and keep historical for good tracking management

• Knowledgeable of NCQA, CAHPS, URAC and CMS requirements

• Computer proficiency ( Windows; Microsoft Project; Word; Excel; Access, Power Point; Outlook; Beginners stage SQL; ODIS, element tool, HybridHelp…etc.)

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