Medical Quality Assurance Specialist resume example with 17+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - -
Professional Summary

A proficient Customer Service Representative with experience working alongside and in support of doctors and medical facilities. Interviewed patients, interpreted test results, performed therapeutic procedures and maintained health and safety-compliant working environment. Excellent clinical, bedside manner, communication, teamwork and health promotion skills.

  • Quality Control Data Compilation
  • Attentive and Observant
  • Testing Documentation
  • Specification Conformance
  • Safety Compliance
  • Test Results Interpretation
  • Chemical Handling
  • Laboratory Equipment Calibration
  • Analytical Methodology Validation
  • Quality Issue Identification
  • Adaptability and Flexibility
  • Consistent Procedure and Protocol Use
  • Data Capture and Analysis
  • Regulator Submission Support
  • Audit Assistance
  • Verbal and Written Communication
  • Statistical Analysis
  • Measurement Collection
  • Contact Laboratory Assessment
  • Attention to Detail
  • Mechanical Operations Monitoring
  • Microsoft Office
  • LabWare LIMS
  • Report Preparation
  • Independent Decision Making
  • Outside Testing Coordination
  • Production Monitoring and Assessment
  • Critical Thinking
  • Sound Judgment
  • Troubleshooting and Diagnostics
  • Data Entry
  • Gauge and Sensor Calibration
  • Hazardous Waste Disposal
  • Problem Solving
Work History
05/2020 to Current
Medical Quality Assurance Specialist The Pediatric Connection Castle Pines, CO,
  • Provided analytical, planning and coordination support on projects as assigned, reviewing, interpreting, analyzing and illustrating data to stimulate and support enlightened decision making.
  • Developed monthly, end-of-quarter and other statistical reports for leadership team and quality improvement programs.
  • Educated employees on specific QA standards and confirmed maintenance of standards.
  • Kept inspection journals and daily summary logs as required.
  • Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
09/2019 to 03/2020
Medicare Coverage Determination and Appeals CVS/Caremark City, STATE,
  • Generated, posted and attached information to claim files.
  • Modified, updated and processed existing policies.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Checked documentation for accuracy and validity on updated systems.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Verified client information by analyzing existing evidence on file.

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10/2002 to 03/2018
LVN/RN Baptist Health System City, STATE,
  • Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
  • Responded to patient requests with appropriate clinical and personal assistance.
  • Performed arterial cut-downs, inserted central lines and inserted endotracheal tubes as part of trauma team.
  • Prepared patients for surgery, educating patients and family members on surgical procedures.
  • Documented patient vitals, behaviors and conditions to communicate concerns to supervising nurse.
  • Took samples to complete diagnostic and routine assessment tests.
  • Assessed patients' temperature, pulse and blood pressure and recorded in electronic medical records.
  • Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
  • Managed patient care through closely monitoring respiration, blood pressure and blood glucose levels.
  • Cared for wounds, provided treatments and assisted with procedures.
  • Delivered updates in patient status to charge nurse, recording changes in medical records.
  • Used aseptic techniques to provide sterilized wound care and dressing applications.
  • Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms.
  • Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
  • Supported physicians during examinations and scans to assist with diagnostic procedures.
  • Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
  • Performed routine evaluations of each patient's status, needs and preferences.
  • Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
  • Comforted and counseled patients and families throughout care process.
  • Managed appointment calendar for scans, lab tests, and evaluations.
  • Performed functional assessments for admission and discharge.
  • Obtained biological specimens for ordered tests and prepared for laboratory transport.
  • Gathered lab specimens, ordered testing and interpreted results to diagnose patients.
  • Educated patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
  • Obtained patient vital signs and input/output measurements from inpatients.
  • Documented accurate and complete patient information to address patient problems and expected outcomes.
  • Collaborated with supervisor to assess patient needs, plan and modify care and implement interventions.
  • Administered controlled narcotics, inserted IVs and performed catheterizations.
Expected in 09/2014
Associates Of Science : Registered Nurse
Galen College of Nursing - San Antonio, TX,
Expected in 05/2010
Associate Degree In Nursing: LVN
Brightwood College - San Antonio, TX,

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Resume Overview

School Attended

  • Galen College of Nursing
  • Brightwood College

Job Titles Held:

  • Medical Quality Assurance Specialist
  • Medicare Coverage Determination and Appeals
  • LVN/RN


  • Associates Of Science
  • Associate Degree In Nursing

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