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HEDIS Lead Resume Example

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HEDIS LEAD
Education and Training
December 2014
Medical Coding Specialist Coastal Carolina Community College － Jacksonville, NC
May 2002
Diploma Gaston College － Lincolnton, NC Licensed Practical Nursing
Skill Highlights
Typing: 65+ WPM *Proficient in Microsoft Office: Word, Excel, PowerPoint, Access *Entry Level proficiency in ICD 9/ICD 10 coding © Copyright 2013 College for America at Southern New Hampshire University. All rights reserved.
Skills
client, clients, data collection, delivery, documentation, Home Health, ICD 10, Medical Coding, Access, Excel, Microsoft Office, PowerPoint, Word, Nursing, direct patient, policies, processes, coding, project management, project planning, project plans, quality, Quality Improvement, reporting, research, Staff Development, supervision, Typing, workflow
Professional Experience
07/2014 to Current
HEDIS Lead Anthem, Inc － Walnut Creek, CA
  • Lead annual HEDIS medical record collection and abstraction process.
  • Prepare and maintain project plans and schedules.
  • Hire, train, and supervise medical record reviewers.
  • Collaborate with multiple departments and external vendors to annually field new HEDIS pursuit applications.
05/2014 to 11/2014
Project Manager Medlinks Cost － Walnut Creek, CA
  • Worked remotely to oversee project team members performing medical record abstraction & audit services.
  • Managed preparation, implementation, and delivery of data collection projects.
  • Maintained compliance with all HIPAA and all other security/privacy policies.
03/2013 to 02/2014
Aqurate Health Data Management Inc., HEDIS Abstractor － Charlotte, NC
  • Reviewed medical records, according to HEDIS specifications.
  • Maintained accuracy as required by Inter-Rater Reliability (IRR) policies and performance standards.
05/2012 to 02/2013
Principal Analyst General Dynamics Information Technology ViPS － Towson, MD
  • Collaborated with managed care organizations to develop, analyze, and interpret custom reporting and documentation for requirements and specifications related to HEDIS reporting and other Quality Improvement efforts.
  • Performed research analysis for health plans and developed recommendations for best practices for enhancements to Quality Improvement policies and procedures.
  • Maintained accuracy as required by Inter-Rater Reliability (IRR) policies and performance standards Identified, evaluated, and recommended clinical business needs, objectives, and requirements Served as a subject-matter expert for clinical aspects of HEDIS measures for all lines of business.
07/2011 to 05/2012
Director of Quality Initiatives InSTAR Solutions － Salt Lake City, UT
  • Coordinated the development, implementation, and evaluation of processes related to all service offerings, including HEDIS, Performance Improvement Projects (PIP's), Risk Adjustment, and all data abstraction projects.
  • Responsible for direct customer oversight, including project supervision, software implementation, and support.
  • Served as subject-matter expert for all hybrid HEDIS measures and project management.
  • Responsible for screening, training, and maintaining clinical abstractors (Staff Development).
02/2007 to 07/2011
Abstraction Services Manager QMark, Inc － Denver, CO
  • Coordinated the preparation of HEDIS (hybrid) data collection projects, including screening and training of abstraction staff, staff and client education, and project planning for various manages care organizations.
  • Analyzed data, directed workflow, prepared reports, and ensured process compliance within guidelines, specifications, and audit requirements.
  • Produced educational resources for abstractors & clients.
  • Field Reviewer-Collected and analyzed medical record data for required HEDIS and NCQA compliance and other various clinical quality studies.
  • Maxim Healthcare., Home Health/Private Duty Nurse.
11/2005 to 12/2011
Charlotte, NC
  • Provided skilled nursing to pediatric and adult patients.
12/2003 to 06/2010
M.A.I./Avenue Homecare, LPN － Charlotte, NC
  • Utilized clinical skills for direct patient contact and daily medical chart reviews & management in various settings, including: Long Term & Rehab, Correctional Facilities, Home Health, and Psychiatric Residential Treatment facilities.
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Resume Overview

Companies Worked For:

  • Anthem, Inc
  • Medlinks Cost
  • Aqurate Health Data Management Inc., HEDIS Abstractor
  • General Dynamics Information Technology ViPS
  • InSTAR Solutions
  • QMark, Inc
  • M.A.I./Avenue Homecare, LPN

School Attended

  • Coastal Carolina Community College
  • Gaston College

Job Titles Held:

  • HEDIS Lead
  • Project Manager
  • Principal Analyst
  • Director of Quality Initiatives
  • Abstraction Services Manager

Degrees

  • Medical Coding Specialist
    Diploma

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