HEDIS Quality Consultant Nurse Resume Example
Love this resume?Build Your Own Now
HEDIS QUALITY CONSULTANT NURSE
Professional Summary
Over 24 years in nursing including medical-surgical, longterm care, rehab, dermatology, plastic surgery. Ten years
in Management including medical office management, store management. Experienced trainer/preceptor in medical data review and analysis. Proof of passing ICD-10
AAPC test. Five years in ICD-9, CPT coding, medical data abstraction, recent utilization review experience. Experienced in HEDIS, NCQA and CMS guidelines.
Licenses
- LPN
- CPC
- Currently in AAPC for CRC- Risk Adjustment Coding
Skill Highlights
|
|
Professional Experience
HEDIS Quality Consultant NurseSep 2015 to Current
Company Name － City, StateMy current focus is CIS- Childhood Immunizations Status but I have worked Closely with Over 12 NCQA HEDIS measures. Initial chart reviews, finale chart over-reads and approvals, medical data collection/abstraction.Provider outreach, hospital outreach, member outreach. Familiar with Qnxt, ImmuNet, NextGen, CRISP.
Company Name － City, StateMy current focus is CIS- Childhood Immunizations Status but I have worked Closely with Over 12 NCQA HEDIS measures. Initial chart reviews, finale chart over-reads and approvals, medical data collection/abstraction.Provider outreach, hospital outreach, member outreach. Familiar with Qnxt, ImmuNet, NextGen, CRISP.
Seasonal HEDIS Review NurseApr 2015 to Jun 2015
Company Name － CityHEDIS review nurse, data abstraction of medical charts. Seasonal temporary work only.
Company Name － CityHEDIS review nurse, data abstraction of medical charts. Seasonal temporary work only.
Utilization Management NurseMar 2014 to Oct 2014
Company Name － City, StateParticipate in collegial review with Statewide Physicians and Regional Physicians of patient cases for medical necessity, applying Milliman and InterQual guidelines to justify decisions. Data entry of ICD-9, CPT codes, distribution of claims approval. Review of claims process for later inquiry as needed.
Company Name － City, StateParticipate in collegial review with Statewide Physicians and Regional Physicians of patient cases for medical necessity, applying Milliman and InterQual guidelines to justify decisions. Data entry of ICD-9, CPT codes, distribution of claims approval. Review of claims process for later inquiry as needed.
Preceptor-TrainerAug 2011 to Feb 2012
Company Name － City, StateTrain and evaluate nurses and CPCs in Medical Data Abstraction, ICD-9, HCC review and HEDIS abstraction.
Company Name － City, StateTrain and evaluate nurses and CPCs in Medical Data Abstraction, ICD-9, HCC review and HEDIS abstraction.
Medical Record Review Nurse ConsultantJan 2010 to May 2011
Company Name － City, StateMedical record review consultant in Risk Adjustment Quality. Promoted to CES-Clinical Education Specialist where I did HCC abstraction, ICD-9 coding, chart audits, development of instructional material. Experienced in projects: HCC, CARA, DRG, HEDIS, and Claims Integrity. Experienced in the following operating systems: SRSA, DCT, Microsoft Power Point, and Microsoft Office/Word.
Company Name － City, StateMedical record review consultant in Risk Adjustment Quality. Promoted to CES-Clinical Education Specialist where I did HCC abstraction, ICD-9 coding, chart audits, development of instructional material. Experienced in projects: HCC, CARA, DRG, HEDIS, and Claims Integrity. Experienced in the following operating systems: SRSA, DCT, Microsoft Power Point, and Microsoft Office/Word.
Co-OwnerJan 2007 to Dec 2015
Company Name － City, StateSmall Family Business with my husband and I purchase property as rental or remodel and sale. Staff of 1-7 depending on sub-contractors on given job site. I also deal with clients. Fielding phone calls, meeting with potential renters and doing background checks, credit checks, verifying employment etc. [We shuttered our company the end of 2015.]
Company Name － City, StateSmall Family Business with my husband and I purchase property as rental or remodel and sale. Staff of 1-7 depending on sub-contractors on given job site. I also deal with clients. Fielding phone calls, meeting with potential renters and doing background checks, credit checks, verifying employment etc. [We shuttered our company the end of 2015.]
Education and Training
Associate of Arts, Licensed Practical Nursing1991Union Memorial Hospital School of Nursing － City, State, USA
1989-1991
Nursing License #LP26522
Certification, CPC2014AAPC － City, State, USACertified Professional Coder ID #01356982
DISCLAIMER
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
Resume Strength
- Formatting
- Word choice
- Length
- Measurable results
- Strong summary
- Typos
Resume Overview
School Attended
- Union Memorial Hospital School of Nursing
- AAPC
Job Titles Held:
- HEDIS Quality Consultant Nurse
- Seasonal HEDIS Review Nurse
- Utilization Management Nurse
- Preceptor-Trainer
- Medical Record Review Nurse Consultant
- Co-Owner
Degrees
- Associate of Arts , Licensed Practical Nursing 1991
Certification , CPC 2014
