I have over 10 years of Healthcare quality experience and is seeking the opportunity to perform quality chart reviewer and Provider & Member engagement/education in the healthcare field. This will enable me to utilize my skills with an opportunity for growth within the position assign. I am confident I can apply my experience with abstraction, coding guidelines, prior authorization for member care and nursing clinical reviews to my extensive qualification skills.

QUALIFICATIONS/SKILLS

• Strong observation and interpersonal communication skills; Advocate for patient’s rights; strive to understand a patient’s needs and concerns.
• Hardworking and energetic; flexible; adapt easily to change of environment and work schedule.
• Maintain critical thinking skills essential to providing competent and dignified in all assigned work.
• Proven ability to create a positive working environment with proven excellent medical record review and remote abstractions, case management and telephonic education.
• Extensive Knowledge with HEDIS, CMS, STARS, NCQA, CAHPS and ICD-9, ICD-10 and CPT Coding experience E/M with the Medicare/Medicaid product and along with claims reviews in various analytical systems.
• Proficient in MS Office applications, Internet, WEBEX, IM, SharePoint and others. System utilize are QSHR, DCT, MedHok, SQL, QNXT, Member360 claims review, eClinicalWorks with great knowledge of other medical information systems. Understand and experiences using EMR & EHR software and application. Assist in project management workflow & data mining
• Member of the AAPC and working toward obtaining my coding certification.
• Extensive experience with medical record review, utilization review, quality improvement, prior authorization for HCC ICD-9 & 10 code for approval through Provider & Member telephonic engagement. Also very knowledgeable with Gap in care for HEDIS supplemental data.