Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
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
08/2015 to Current
HEDIS Quality Consultant NurseAffinity Health Plan Inc – Bronx, NY, My 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.
03/2015 to 05/2015
Seasonal HEDIS Review NurseMarriott International – Grapevine, , HEDIS review nurse,
data abstraction of medical charts. Seasonal temporary work only.
02/2014 to 09/2014
Utilization Management NurseWexford Health Source – City, STATE, Participate 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.
07/2011 to 01/2012
Preceptor-TrainerInovalon, Inc – City, STATE, Train and evaluate nurses and CPCs in Medical Data
Abstraction, ICD-9, HCC review and HEDIS abstraction.
2010 to 04/2011
Medical Record Review Nurse ConsultantInovalon, Inc – City, STATE, Medical 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.
2007 to 11/2015
Co-OwnerSavvy Investment Properties LLC / Schaechtel Property Management LLC – City, STATE, Small 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
Expected in 1991
Associate of Arts: Licensed Practical Nursing Union Memorial Hospital School of Nursing - Baltimore, MD GPA:
1989-1991
Nursing License #LP26522
Expected in 2014
Certification: CPC AAPC - Baltimore, MD GPA: Certified Professional Coder ID #01356982
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