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Joyce
Jpearl28@yahoo.com
585-489-9476
1123 10th Street North
Saint Petersburg, FL 33705
LPN PRODUCT EXPERT, QUALITY IMPROVEMENT SPECIALIST-Nurse-HEDIS (teleworker)
17 years experience W2
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Summary

Experience
LPN QUALITY IMPROVEMENT SPECIALIST-Nurse-HEDIS (teleworker)
Information Technology
Dec 2018 - present

Optum Health Insurance-United Healthcare

  • Member of Clinical Quality Oversight team with the Risk, Quality, and Network Solutions Program.
  • Product Expert providing HEDIS expertise. Thorough understanding of HEDIS measures and details.
  • Over reader, checking thousands of HEDIS abstractor's work for accuracy.
  • Data abstractor requiring 98 percent accuracy.
  • Input into database.
Optum LPN HEDIS Nursing
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QUALITY IMPROVEMENT SPECIALIST-Nurse-HEDIS (teleworker)
Medical Devices
Jan 2017 - May 2017
Contract Job
  • Responsible for collecting and abstracting HEDIS measures from medical records for Medicaid and Medicare Advantage Care members
  • Coordinated visits to physicians' offices, made appointments and collaborated with staff
  • Utilized many different EMR systems to precisely abstract gaps in HEDIS data.
  • Temporary contract job.
Nursing Medicare Medical Records HEDIS EMR Medicaid
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QUALITY IMPROVEMENT NURSE CONSULTANT-Nurse-HEDIS-FULL TIME (TELEWORKER)
Medical Devices
Jun 2013 - Jan 2017
Employment ended January 2017 due to optional buyout program.
  • Improved CMS Medicare Stars ratings of providers to 4 stars or above by providing PCP/member specific metrics, office staff education, and member outreach. Worked with metrics such as HEDIS measures, star ratings, COA, CAPS and HOS, and Medicare Part D to help increase scores.
  • Educated providers about monetary incentives, such as flu shot incentives, and HEDIS measures.
  • Created action plans, Quality Improvement forms, Excel spreadsheets, and gap reports specifically tailored for individual providers and MSOs to improve performance.
  • Established trusting, cooperative relationships with PCP offices and MSOs which facilitated collaboration, ' cooperation and an increase in scores and incentives.
  • Assisted PCPs and staff with Medicare Stars and HEDIS technicalities -coding including non-reimbursable F codes, gap lists, and educational materials.
  • Worked with pharmacy and PCPs to increase Medicare Part D scores.
  • Attended JOC (joint operating committee) meetings to give updates on closing compliance gaps.
  • Conducted in depth medical chart review looking to close compliance gaps. Accurate capturing of data and entering into various data bases. Educated coders about proper codes to capture compliance data.
Compliance HEDIS Medicare Nursing Pharmacology MS Excel
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QUALITY IMPROVEMENT SPECIALIST- Nurse - HEDIS (teleworker)
Medical Devices
Jan 2012 - Jan 2013
Responsible for collecting and abstracting HEDIS measures from medical records for Medicaid and Medicare Advantage Care members.
  • Entered information and corrections into ACESS data base to improve rate of accuracy and failures prior to audits.
  • Coordinated visits to physicians' office, made appointments and collaborated with staff
  • Utilized many different EMR systems to precisely abstract gaps in HEDIS data.
  • Temporary contract job for two HEDIS seasons. Joyce P. Paisner, LPN, CPC 1123 10th Street North St Petersburg, Florida 33705 Phone: 585-489-9476 Jpearl28@yahoo.com
EMR HEDIS LPN Medicaid Medicare Nursing Audit Medical Records CPC
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FOUNDER/OWNER
Jan 2005 - Jan 2013
Provant per diem contract
  • Health screener for corporate health fairs sponsored by insurance companies.
  • Proficient in all stations, fingerstick, BP, height, weight and anything other screenings requested.
No skills were added
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Jan 2011 - Jan 2012
Managed and coordinated onsite corporate health screening events around the country.
  • Effectively led teams of health screeners to promote health and wellness to insurance members.
  • Required independent and creative thinking and sole responsibility handling supplies, managing team members, {education mentoring, training} and communicating with high level corporate managers.
Project Management
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QUALITY IMPROVEMENT SPECIALIST- Nurse - HEDIS (teleworker)
Medical Devices
Jan 2008 - Jan 2011
Responsible for over reading, collecting and abstracting HEDIS measures from medical records for Medicaid and Medicare Advantage Care members.
  • Entered information and corrections into ACESS data base to improve rate of accuracy and failures prior to audits.
  • Coordinated visits to physicians' office, made appointments and collaborated with staff
  • Also an over read nurse
  • checking other nurses entries into the data base. Required great attention to detail.
  • Utilized many different EMR systems to precisely abstract gaps in HEDIS data.
  • Temporary contract job for three HEDIS seasons.
EMR HEDIS Medicaid Medicare Nursing Medical Records Audit
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MEDICARE RISK ADJUSTMENT SITE REVIEWER
Jan 2009 - Jan 2011
Conducted on site risk adjustment reviews based on HCC and ICD-9-CM codes. Required attention to detail, data entry and coding accuracy and coding expertise. Sensitivity to workplace differences. Contract job.
Medicare ICD-9 Risk Adjustment
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Edit Skills
Non-cloudteam Skill
Education
perfect score on licensing boards and was a scholarship recipient
Hiram College
Certifications
CPC
Licensed Practical Nurse
CPC certificate, with previous HCC coding experience
Health and Wellness Coach certification from Totally Coached Inc
HIPPA certified
Cholestech certified
Florida Driver's License
Skills
HEDIS
2021
10
Nursing
2021
10
Medicare
2017
7
Audit
2013
4
EMR
2017
4
Medicaid
2017
4
Medical Records
2017
4
Compliance
2017
3
LPN
2021
3
MS Excel
2017
3
Pharmacology
2017
3
ICD-9
2011
2
Optum
2021
2
Risk Adjustment
2011
2
CPC
2013
1
Project Management
2012
1