Clinical Quality Improvement Specialist Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Enthusiastic individual with superior skills in working in both team-based and independent capacities. Bringing strong work ethic and excellent organizational skills to any setting. Excited to begin new challenge with successful team.

  • Administrative support
  • Insurance billing
  • Supervision
  • Business operations
  • MS Office
  • Customer service
  • Patient services coordination
  • Job performance evaluations
  • Electronic medical records
  • Medical records management
  • Documentation and reporting
  • Clinical Quality Improvement
  • Regulatory compliance
  • Quality assurance controls
  • Documentation procedures expert
  • Medical terminology knowledge
  • Electronic charting
  • Outstanding computer proficiency
  • First Aid/CPR
  • BILINGUAL (Spanish)
Clinical Quality Improvement Specialist, 06/2018 to 12/2019
Northwell Health Port Washington, NY,
  • Evaluated Oasis and Care Plans against quality requirements to maximize efficiency.
  • Gathered and inputted data in Kinnser, IGEA, & other medical data software to develop physician ordered care plans and Medicare required Oasis reports.
  • Analyzed issues with nursing, therapy, and aide notes and recommended corrective actions to improve final results.
  • Achieved cost-savings by developing functional solutions to Oasis and care plan problems.
  • Worked closely with team members to deliver Medicare requirements, develop solutions and meet Medicare deadlines.
  • Handled all delegated tasks, including Oasis and care plan creation and QA.
Home Health Care Administrator/Owner/Operator, 03/2008 to 03/2018
E & L Health Services, Inc City, STATE,
  • Developed care plans, covering goals based on nursing diagnosis and incorporating therapeutic, preventive and rehabilitative nursing actions.
  • Resolved issues in the field by notifying the nursing supervisors and corresponding physicians immediately to determine the course of action.
  • Communicated with primary care physicians or emergency care providers to relay patient needs.
  • Provided training and supervision to 60+ member staff both internal and field positions.
  • Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
  • Coordinated care for up to 120 patients per shift in busy home health setting.
  • Developed and maintained quality care systems and standards, including creating and improving medical protocols and guidelines.
  • Imparted medical, operational and patient care knowledge to clinical and non clinical staff to maximize performance and quality of team operations.
  • Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management.
  • Managed and provided leadership to help staff with direct and indirect patient care and telemetry monitoring.
  • Offered clinical leadership and oversight to entire home health care agency including daily scheduling, tasking and administration.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Maintained infection control logs, streamlined charting process, and improved patient outcomes through training and leadership.
  • Ensured quality patient care from admission to discharge through direct supervision of all nursing and ancillary staff.
  • Guided employees through routine and complex administrative situations with decisive but motivational approach.
  • Elevated productivity initiatives by managing client and international executive calendars, including coordinating itinerary, scheduling appointments and managing both internal and external communications.
  • Managed all business files, documentation and databases to keep records secure, accurate and current.
Office Billing Manager, 05/2005 to 03/2008
Eccolab Group City, STATE,
  • Prepared monthly and year-end closing statements, financial documents, and invoices.
  • Maintained historical records by microfilming and filing documents.
  • Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
  • Created receiving reports and updated vendor balance sheets to record accounts payable.
  • Eliminated billing inaccuracies by reconciling accounts monthly.
  • Prepared billing statements for patients, ensuring correct diagnostic coding.
  • Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
  • Maintained current working knowledge of CPT and ICD coding principles, government regulation, protocols and third-party billing requirements.
  • Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Reviewed and verified benefits and eligibility with speed and precision.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
  • Determined prior authorizations for medication and outpatient procedures.
  • Consistently informed patients of financial responsibilities prior to services being rendered.
  • Evaluated accuracy of provider charges, including dates of service, procedures, and level of care and diagnoses.
  • Billed all lab claims with attached lab slips.
  • Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
  • Maintained detailed records and completed regular reports for operations, accounting and human resources needs.
  • Managed financial documentations such as expense reports and invoices.
Education and Training
Bachelor of Science in Nursing (BSN): Nursing Science, Expected in 07/2017
EDP University of Puerto Rico, San Sebastian, US - San Sebastian, PR, US,
  • Summa cum laude graduate
Associate of Science in Nursing (ASN): Nursing Science, Expected in 08/2016
EDP University of Puerto Rico, San Sebastian, US - San Sebastian, PR, US,
  • Summa cum laude graduate
Medical Billing & Coding Degree: Medical Insurance Billing, Expected in 05/2005
Everest Institute - Miami, FL,
  • Completed coursework in medical insurance billing and coding obtaining my degree.
High School Diploma: , Expected in 06/2003
G. Holmes Braddock Senior High School - Miami, FL

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Resume Overview

School Attended
  • EDP University of Puerto Rico, San Sebastian, US
  • EDP University of Puerto Rico, San Sebastian, US
  • Everest Institute
  • G. Holmes Braddock Senior High School
Job Titles Held:
  • Clinical Quality Improvement Specialist
  • Home Health Care Administrator/Owner/Operator
  • Office Billing Manager
  • Bachelor of Science in Nursing (BSN)
  • Associate of Science in Nursing (ASN)
  • Medical Billing & Coding Degree
  • High School Diploma

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