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Quality Specialist/Medical Record Reviewer Resume Example

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QUALITY SPECIALIST/MEDICAL RECORD REVIEWER
Professional Summary

Conscientious, results-oriented healthcare professional, with specialization and education in Health Information Management. Attention to detail, strong proofreading and interpersonal skills with the ability to work independently and prioritize concurrent work tasks. Strong understanding of confidential and sensitive matters where independent judgment and discretion must be exercised. Energetic, motivated organizer with solid multi-tasking and managerial skills. Extensive experience with public interaction, promotes good relations through effective communications. Strong decision maker who understands the importance of compassion and patience. Strong work ethics and a passion for the pursuit of excellence in the workplace. Skill Highlights Medical terminology Microsoft Office Suite Electronic Medical Record (EMR) software Proven patience and self-discipline ICD-9 coding Personal and professional integrity CPT coding Relationship and team building HIPAA compliance Sound decision making Maintains strict confidentiality Cultural awareness and sensitivity Team player with positive attitude Problem resolution Strong work ethic Office Administration

Skill Highlights
  • Extensive anatomy/physiology knowledge
  • Electronic Medical Record (EMR) software
  • ICD-9 coding
  • CPT and HCPCS coding
  • HIPAA compliance
  • Patient charting
  • Medical terminology
  • Strong interpersonal skills
  • Strong work ethic
  • Team player with positive attitude
  • Deadline-driven
  • Good written communication
  • Exercises good judgment
  • Maintains strict confidentiality
  • Microsoft Office proficiency
  • Self-directed
  • Strong problem solver

Skills

Medical records auditing, data entry, databases, documentation, drafting, editing, filing, forms, functional, insurance, Legal, director, materials, Medical terminology, meetings, access, office, organizational, personnel, print shop, processes, progress, project management, protocols, Quality, quality assurance, quality control, rapport, reporting, researching, scheduling, shipping, teaching, Technician, workflow

Professional Experience
Quality Specialist/Medical Record Reviewer
October 2013 to July 2014Company Name － City, State
  • Laws and regulations on the confidentiality of Medical Records (i.e.
  • Privacy Act, Freedom of information Act, and Army Regulation 40-66) governing the release of medical information or health records in response to inquiries from patients, their authorized representatives and other third parties.
  • Medical records, forms, and content to respond to requests for medical information for accuracy and completeness.
  • Medical terminology to code records and identify material to be copied and released.
  • Legal and regulatory requirements of medical records to ensure the record is acceptable as a legal document.
  • Procedures, rules, and operational sequence of documentation requirements, time requirements, functions and workflow to process release of information.
  • Computerized data entry and information processing systems to ensure HIPAA compliance.
  • Patient privacy and confidential patient information Maintenance of administrative and procedural processes to improve accuracy and efficiency.
  • Coordination admission processes and preparation of medical records and agreement packets.
  • Processed and ensured confidential patient information.
HIM Internship
March 2013 to March 2013Company Name － City, State
  • Strictly followed all federal and state guidelines for release of information.
  • Ensured compliance with medical/legal requirements, The Joint Commission standards and Army regulations.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Accurately assembled and analyzed medical records.
  • Trained on the facilities procedures, rules, and operational sequence of medical records, forms, and content to respond to documentation requirements.
  • Familiarity with the computerized data entry and information processing systems Armed Forces Health Longitudinal Basic knowledge of Technology Application (AHLTA), and Composite Health Care System (CHCS) to retrieve and print lab reports, radiology reports, medication lists, and appointment lists.
HIM Internship
May 2012 to July 2012Company Name － City, State
  • Assisted Medical Record technician to compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system.
  • Assisted patients in completing ROI forms.
  • Recorded and filed patient data and medical records.
  • Strictly followed all federal and state guidelines for release of information.
  • Ensured compliance with medical/legal requirements standards.
  • Fulfilled requests to print patient information.
  • Documented patient encounters.
  • Delivered medical record delinquency notices to physicians for correction.
  • Matched paperwork with patient's demographics.
  • Maintained detailed administrative and procedural processes to improve accuracy and efficiency.
  • Assembled and analyzed medical record.
  • Scanned medical record for coders.
Project Coordinator
February 2007 to October 2009Company Name － City, State
  • Successfully created, and established business protocols.
  • Spearheaded and created operations manual to assist internal personnel in understanding the various functions and processes.
  • Appropriately and correctly coordinated with team members on defining and implementing procedures to meet deadlines and quality control.
  • Successfully managed various aspects of a large brand conversion project for a national pharmacy chain including implementing automated distribution system.
  • Improved the distribution process by developing a methodology to maintain detailed records of all architectural designs, as well as internal and external reporting capabilities.
  • Supervised planning scheduling, production and shipping of products.
  • Defined project deliverables and monitored status of tasks.
  • Drafted action plans, led meetings with department executives to review project status, and proposed changes.
  • Collaborated with cross-functional teams to draft project schedules and plans.
  • Monitored team progress and enforced deadlines.
State Filing Analyst
July 2001 to June 2006Company Name － City, State
  • Successfully determined product/business filing requirements by researching legislative information, competitor information and preexisting medical products.
  • Worked closely with clients and state examiners to draft and then finalize policy forms.
  • Maintained a strong working rapport with insurance departments, businesses and operation personnel.
  • Ensured that policy forms and rates complied with the legal and regulatory requirements for each state.
  • Analyzed new regulatory issues and requirements, and implemented required changes, distributed information internally, and re-filed forms and rates as appropriate with state authorities.
Forms Administrator
January 2000 to July 2001Company Name － City, State
  • Successfully coordinated all forms requests for clients and maintained databases for distributions and supply orders.
  • Instrumental in formatting a process flow and standardized order form for supply orders.
  • Responsible for drafting and.
  • editing of property and casualty forms for submission to the print shop, and the verification of printed form quality.
Lead Teacher
January 1996 to January 2000Company Name － City, State
  • Promoted good behaviors by using the positive reinforcement method.
  • Maintained daily records of children's individual activities, behaviors, meals and naps.
  • Created and implemented developmentally appropriate curriculum that addressed all learning styles.
  • Established a safe play environment for the children.
  • Encouraged children to be understanding of others.
  • Maintained a child-friendly environment with access to outdoor activities.
  • Incorporated music, art and theater into lesson planning.
  • Developed professional relationships with parents, teachers, directors and therapists.
  • Worked closely with the site director, family care workers, classroom teaching team and other specialists.
  • Collaborated with colleagues on developing new classroom projects and monthly themes.
Office Manager
May 1991 to January 1996Company Name － City, State
  • Successfully oversaw all office functions, which included: Assisting the project manager with bidding new jobs and.
  • projects.
  • Prepared and processed all contracts, ordering, inventorying of all building materials.
  • Liaison between.
  • architects and the general contractors.
  • Maintained detailed administrative and procedural processes to improve.
  • accuracy and efficiency.
  • Accurately provided status information on project progress to the project management.
Education and Training
Associate of Applied Science : Health Information Management, 1 2013Northern Virginia Community College － City, State, USAGPA: Magna Cum Laude GPA: 3.5

Health Information Management Magna Cum Laude GPA: 3.5 Graduated with honors.

Associate of Applied Science : Health Information Management, 2013Northern Virginia Community College － City, State, USAGPA: Recipient of the Service Excellence Academic Leadership (SEAL) Award 2013 Who's Who among Students in American Universities and Colleges Award for proven record of outstanding accomplishment and merit- 2013 HIMSS NCA Chapter Scholarship Winner

Recipient of the Service Excellence Academic Leadership (SEAL) Award 2013

Who's Who among Students in American Universities and Colleges Award for proven record of outstanding

accomplishment and merit- 2013

HIMSS NCA Chapter Scholarship Winner

Certifications and Credentials

RHIT Certification -2013

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Resume Overview

School Attended

  • Northern Virginia Community College

Job Titles Held:

  • Quality Specialist/Medical Record Reviewer
  • HIM Internship
  • Project Coordinator
  • State Filing Analyst
  • Forms Administrator
  • Lead Teacher
  • Office Manager

Degrees

  • Associate of Applied Science : Health Information Management , 1 2013
    Associate of Applied Science : Health Information Management , 2013

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