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Hedis Coordinator (Contract) Resume Example

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HEDIS COORDINATOR (CONTRACT)
Professional Summary
With broad experience implementing a variety of programs contributing towards achieving company profitability goals, I have the ability to assess and resolve a wide range of issues and am results oriented.  I am highly effective in partnering with managers and employees and identifying initiatives, areas requiring improvement and implement appropriate resolutions. With strong interpersonal and customer service skills, I have the ability to work accurately to meet deadlines and maintain an effective working relationship with patients and clinic staff. My computer skills include but are not limited to, Microsoft Word, Excel, AND Outlook, PowerPoint, and Multiple EMR Systems. I type 55 WPM. Based on my experience, knowledge, and ability to adapt to any job situation, I am an asset to any company. I enjoy and take a great deal of pride in the work I'm performing. I know I exceed what is expected of me in assuring the successful operation of the company I work for.
Skills
  • Strategic planning capability
  • Planning and development
  • Analytical thinker
  • Accomplished leader
  • Supervisory training
  • Knowledge of Medicaid statutes and regulations
  • Medical terminology expert
  • Records management professional
  • Billing and collection procedures expert
  • Patient referrals expert
  • MEDISOFT proficient
  • Efficient and reliable team player
  • Medicaid Management Information Systems
Work History
Hedis Coordinator (Contract), 11/2015 to 01/2016
UnitedHealth Group – Tampa, FL
  • Work with multiple EMR systems such QSHR, HTA, Healthport, Altegra, ISET and ILead 
  • Help vendors obtain medical records according to pend detail and measure
  • Excel workbench includes daily report run for daily activity
  • Schedule onsite and remote meetings to obtain medical records
  • Fax and follow up on providers with missing, incomplete or non-compliant charts and updating demographics
  • Following all measures for compliance of the NCQA (National Committee for Quality Assurance)
Credentialing/Provider Enrollment , 06/2015 to 11/2015
Shriners Hospital for Children – Tampa, FL
  • Credentialing all billable and non-billable providers
  • Maintaining each CAQH profile by keeping the application current and within its 60 day grace period  
  • Communication between all health insurance companies to develop or maintain a relationship including Nationals, Group contracts, and Local Plans
  • Develop and implement education and training materials to facilitate payer-specific guidelines and diffused into practice
  • Monitor, interpret and deploy NCQA payer and provider quality standards
  • Facilitates regular reporting to internal departments, hospitals and headquarter leadership
  • Establish and maintain close working relationships with hospital credentialing coordinators, network management, providers, and payer contracts to expedite provider enrollment turnaround time  
  • Plan and manage projects, budget and resource allocation  
  • Coordinate with Network Management to deploy health plans  
  • Validate provider enrollments with health plans and coordinate with plans to ensure provider status is published and deployed to mitigate denials for professional fees
  • Provide education with Care Management team to Optimize Health plan resource utilization  
  • Outlook Email, Excel- Advanced, OneHealthPort Credentialing systems, CAQH
Licensing/Credentialing, 11/2014 to 06/2015
BillDME Licensing Manager – Tampa, FL
  • Team leads all sales and staff on rule and regulation updates, including Stark Law and Safe Harbor Laws
  • Create policies and procedures for providers expecting inspection 
  • LLC-CORP formation completion and follow-up
  • Licensing application completion and accurately inputted into EMR
  • Banking formation completion
  • Discussing contract with all providers of interest in becoming their own suppliers
  • Medicare and Medicaid Enrollment Process within Medicare guidelines
  • Registration on patients all over the USA Major Medical
  • Monitored all major insurance contracts for Doctors to become within the Network for DME
  • Build cases with Medisoft
  • Update Excel spreadsheets daily on all states and locations
  • Micro-manage all Licensing Departments
  • Chart reviews, prepare charts for billing cycle
  • Outlook Email, Excel-Intermediate, Powerpoint-Beginner, Word-Advanced, EMR - Sage Act
Patient Service Coordinator, 10/2013 to 05/2014
Internal Medicine – St. Petersburg, FL
  • EMR-E-Clinical/Centricity/Athena
  • Verified and entered insurance information, including Medicare, Medicaid, Medi-pass, HMO, PPO and Availity
  • Worked with the Fax inbox sending each document to the correct doctor/nurse or manager Scheduled and monitored appointments through Athena/Centricity
  • E-ClinicalProfessional
  • Provide explanation of benefits EOBS, collect co-payments and coinsurance
  • Perform filing, faxing and type medical correspondence, scan all records into EMR-E Clinical systems 
  • Type referrals for patients to see specialist
  • Reconcile end of month received cash/check/co-payments
  • Managing HEDIS Care Gaps, scheduling patients for Diabetic Education and all preventative care
  • Send Medical Records to insurance companies
  • Check patients in/out with follow-up and print visit summaries for meaningful use documentation 
  • Credentialing the physician with all available insurance companies
Medical Administrative Assistant, 2010 to 2010
Dr. Leopoldo Grauer (Externship) – Tampa, FL
  • Schedule appointments, answer phones, transfer calls to appropriate personnel, take messages
  • Verify insurance, including Medicare and Medicaid
  • Provide explanation of benefits EOB/s and collect co-payments
  • Performed filing, faxing, and typed medical correspondence
  • Check inventory of office medical supplies, accurately listed supplies to restock
  • Check vital signs, blood pressure, height and weight, take patient's medical history and prepare patients for examination


Education
Associate of Applied Science: Medical Administration , 2010
Everest University - Tampa, FL

Relevant Coursework: 

  • Office Finance
  • Billing and Coding
  • Patient Processing and Assisting
  • Insurance Plans and Collections 
  • Medical Office Policies/Procedures
  • Dental Administrative Procedures 
  • Medical Insurance MMA/MDA
  • Microsoft Suite
GED: 2010
Brewster Technical Center - Tampa, FL
Certifications
  • OSHA
  • HIPAA
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Resume Overview

Companies Worked For:

  • UnitedHealth Group
  • Shriners Hospital for Children
  • BillDME Licensing Manager
  • Internal Medicine
  • Dr. Leopoldo Grauer (Externship)

School Attended

  • Everest University
  • Brewster Technical Center

Job Titles Held:

  • Hedis Coordinator (Contract)
  • Credentialing/Provider Enrollment
  • Licensing/Credentialing
  • Patient Service Coordinator
  • Medical Administrative Assistant

Degrees

  • Associate of Applied Science : Medical Administration , 2010
    GED : 2010

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