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HEDIS Quality Consultant Nurse Resume Example

Resume Score: 60%

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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
  • ICD-9, ICD-10
  • InterQual, Milliman
  • Customer Service
  • HCC Coding
  • NCQA, CMS
  • Preceptor/Educator
  • Chart Abstraction
  • HEDIS
Professional Experience
HEDIS Quality Consultant NurseSep 2015 to Current
Maryland Physicians Care - Linthicum, MDMy 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
Altegra - Remote TeleworkHEDIS review nurse, data abstraction of medical charts. Seasonal temporary work only.
Utilization Management NurseMar 2014 to Oct 2014
Wexford Health Source - Columbia, MDParticipate 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
Inovalon, Inc - Annapolis, MDTrain 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
Inovalon, Inc - Bowie, MDMedical 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
Savvy Investment Properties LLC / Schaechtel Property Management LLC - Severna Park, MDSmall 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 - Baltimore, MD, USA
1989-1991
Nursing License #LP26522
Certification, CPC2014AAPC - Baltimore, MD, USACertified Professional Coder ID #01356982
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Resume Overview

Companies Worked For:

  • Maryland Physicians Care
  • Altegra
  • Wexford Health Source
  • Inovalon, Inc
  • Savvy Investment Properties LLC / Schaechtel Property Management LLC

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

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