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Healthcare Effectiveness and Information Set Coordinator (HEDIS) Resume Example

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HEALTHCARE EFFECTIVENESS AND INFORMATION SET COORDINATOR (HEDIS)
Summary

To obtain a position which utilizes and enhances my education and work experience with the Potential for career advancement. Recognized for long hours, commitment to customers, attention to detail and follow up. Work well as a team member or independently and under pressure. Demonstrates ability to meet the needs of patrons, dependable, hardworking and punctual. Excellent basic clerical and computer skill including knowledge of Microsoft Office. Excellent interpersonal, listening and communication; both written and spoken skills. Sound ability to keep sensitive information confidential. Sound organization skills, goal- oriented, proactive, and excellent at reporting.

Highlights
  • Proficient with Healthcare Effectiveness Data and Information Set (HEDIS)
  • Proficient with Georgia's Medical Management Information System (MMIS)
  • Proficient with Georgia Registry of Immunization Transactions and Services (GRITS)
  • Excellent communication skills
  • Advanced clerical knowledge
  • Filing and data archiving
  • Medical billing
Accomplishments

Provided award winning customer service to Consumer Cellular as well as AARP

Members with ordering easy to use cell phones

Experience
Healthcare Effectiveness and Information Set Coordinator (HEDIS) 04/2014 to Current Centene Corporation Peach State Health Plan Atlanta, GA
  • Handle inbound/outbound member calls and assist them in obtaining service, appointment scheduling, arranging transportation, and initiating reminder calls, e-mails and/ or faxes.
  • Educate and inform members about current and past due clinical services which improves member health outcomes and increases Health Plan HEDIS rates.
  • Conduct HEDIS provider chart request calls to support medical record capture for HEDIS supplemental data review and abstraction.
  • Record and document all member and provider outreach activity using Microsoft Office Suite applications and web-based technology.
  • Review member plan eligibility using Georgia's Medical Management Information System (MMIS).
  • Review member claims data to determine need for services using the Health Plan Proprietary Information system or Georgia Registry of Immunization Transactions and Services (GRITS).
  • Identify and refer members to internal programs and services i.e. Case management and Disease Management,
  • Maintain strict confidentially and compliance with Health Insurance Portability and Accountability ACT during outreach activities.
Data Entry/File Clerk/ Receptionist/ Customer Service Rep 10/2013 to 01/2014 WRI Property Management Marietta, GA
  • Entered information from lease into the system.
  • Pulled, Filed, and Organized Resident Lease's, in Numeric and Alphabetic order.
  • Worked the front window and signed in assisted walk-in clients.
  • Answered incoming calls, provided information about properties that are move-in ready, and contact leasing agents for information that assist with with more information the property, and transferred all other calls to the appropriate department.
Customer Service/ Pharmacy Technician 10/2012 to 08/2013 McKesson Scottsdale, AZ
  • Provided customer service to patients who wanted or needed to save money on name brand prescription drugs.
  • Activated/Deactivated Rx Discount cards for qualifying and non-qualifying patients.
  • Assisted pharmacist and pharmacy technicians with proper steps on how to bill the Rx discount cards.
  • Verified card benefits, provided override codes when needed and reversed paid claims upon request.
Passport II Specialist 02/2012 to 09/2012 Vangent, a General Dynamics Company Phoenix, AZ
  • Provide General Information for customers who need assistance with obtaining a U.S. Passport.
  • Educate customers about personal account information and their minors Passport.
Customer Service/ Inbound Sales Rep 01/2011 to 12/2011 Consumer Cellular Phoenix, AZ
  • Provided award winning customer service to Consumer Cellular as well as AARP Members with ordering easy to use cell phones.
  • Took bill payments as well as made payment arrangements on account balances.
Customer Service/ Inbound Sales Rep 08/2010 to 01/2011 Sears Holding Center Tempe, AZ
  • Assisted with ordering large appliances over the phone for customers.
  • Provided online assistance when needed and education about appliances.
  • Assisted with setting up appointments for cleaning , repair and delivery.
Customer Service/ Sales Rep 06/2008 to 12/2009 Stream (Etelecare) Global Solutions Phoenix, AZ
  • Provided award winning customer service to Sprint/Nextel and satisfy customers on every call.
  • Assisted customers with paying their bills as well as reading bills, sold phones and accessories, ported customers to Sprint/Nextel.
  • Handled account modifications and all account needs.
  • Assisted with technical support for the Peek device activated and deactivated services when needed or upon request.
Debt Collector 02/2008 to 05/2008 Collectcorp Phoenix, AZ
  • Assisted with every day transactions as instructed.
  • Attended Owens Community College after work hours.
File Clerk and Backup Receptionist 08/2007 to 10/2007 State of Arizona Comprehensive Medical and Dental Program Phoenix, AZ
  • Alpha and Numerical Medical Record Filing for the Claims Department.
Sales Associate 05/2006 to 12/2006 Anchor Blue at Arizona Mills Tempe, AZ

Performed all duties as instructed.

Education
H.S. Diploma 2007 Humanities and Science Institute (ICI) Phoenix, AZ
Skills

Customer service, delivery, faxes, Filing, Insurance, Microsoft Office Suite, Management Information System, reading, scheduling, technical support, technician, phones. transportation

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Resume Overview

Companies Worked For:

  • Centene Corporation Peach State Health Plan
  • WRI Property Management
  • McKesson
  • Vangent, a General Dynamics Company
  • Consumer Cellular
  • Sears Holding Center
  • Stream (Etelecare) Global Solutions
  • Collectcorp
  • State of Arizona Comprehensive Medical and Dental Program
  • Anchor Blue at Arizona Mills

School Attended

  • Humanities and Science Institute (ICI)

Job Titles Held:

  • Healthcare Effectiveness and Information Set Coordinator (HEDIS)
  • Data Entry/File Clerk/ Receptionist/ Customer Service Rep
  • Customer Service/ Pharmacy Technician
  • Passport II Specialist
  • Customer Service/ Inbound Sales Rep
  • Customer Service/ Sales Rep
  • Debt Collector
  • File Clerk and Backup Receptionist
  • Sales Associate

Degrees

  • H.S. Diploma 2007

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