To obtain a position within a progressive environment that will provide challenges and opportunities for personal and professional growth.
HEDIS Data Analyst04/2013 to CurrentCareSourceDayton, OH
Responsible for various HEDIS data submissions to state and federal agencies on a timely basis, ensuring the quality of the data submitted meets, at a minimum, the various regulatory requirements.
Responsible for running and utilizing CareAnalyzer (NCQA HEDIS Certified Software) to obtain HEDIS measure rates for monthly and annual reporting to management.
Work with the Application Development team to ensure the accuracy of programs used to create HEDIS data submission files and that these programs are kept updated for the latest requirements (both CareSource requirements and regulatory).
Responsible for testing CareAnalyzer upgrades.
Monitor and devise action plans to address HEDIS data that is rejected by agencies.
Work with Quality Improvement, Claims and other operational business owners to ensure accuracy of HEDIS data.
Work with Quality Improvement, Claims and other operational business owners to ensure appropriate actions take place to address rejections as well as ensure reprocessing of previously rejected data.
Ensure HEDIS data is submitted both timely and accurately to NCQA.
Utilize both Microsoft Excel and SAS programming for analysis.
Data Collection Specialist11/2010 to 04/2013PriMed PhysiciansCenterville, OH
Responsible for maintaining and assembling factual technical data, generating required reports, and coordinating statistics for reports by accurately abstracting data/information from the medical record according to the specific criteria of the project.
Responsible for reviewing the medical record (electronic and paper) and extracting demographic, clinical and non-clinical data with high integrity and consistency.
Responsible for performing audits for applicable medical quality programs (Hypertension, Diabetes, NCQA, PQRS, HEDIS, and Asthma).
Responsible for all external audit scheduling which includes HEDIS and Medicare Advantage audits by various healthcare insurance companies.