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Quality/Utilization Administrator Resume Example

Resume Score: 80%

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Rachel
Voegele-Hughes
Professional Summary

Self-motivated, future oriented administrative professional seeking a full-time position in the healthcare industry. Bringing 6+ years of professional and educational experience to the table I specialize in leadership and have a proven success rate in improving processes used in small and large healthcare corporations. Motivated by the opportunity to learn, grow, excel and be apart of a wonderful team in the healthcare industry, working together to change the healthcare field for the better.

Education
Oklahoma State UniversityStillwater, OKExpected in 05/2022MBA: Healthcare Administration
  • Minor Global Health
Madonna UniversityLivonia, MI12/2019Bachelor of Science: Health Services Administration
  • Graduated magna cum laude
Skills
  • Office administration
  • Project Management
  • Customer service
  • Population/ Community Health
  • Health Insurance
  • Problem Solving
  • Team Leader
  • Performance improvement
  • MS Office
  • Time Management
  • Risk Management
  • Medical Billing
  • EMR
  • Project organization
  • Healthcare facility management
  • Business operations
Certifications
  • MICMT Complex Care Management (CM)
  • Motivational Interviewing
  • Interpersonal Communication
  • Medical Assistant (MA)
  • First Aid/CPR/AED Certified
  • HIPPA Professional
  • Million Hearts Fellow
  • Basic Medical Billing (CPT, ICD10)
  • Blood Borne Pathogens
Volunteer Work
  • Ronald McDonald House
  • American Good Fellows (No Child Without a Christmas)
  • St. Edith Church Free Health Screenings
  • Gleaners Food Pantry
  • Mentor for High School Youth
  • Love Your Mellon (Madonna University
  • Meals on Wheels
  • DMC Children's Hospital Volunteer (Activities, Patient Sitting, Room Decorating, ect.)
Work History
Twelve Oaks Pediatrics PLLC- Quality/Utilization Administrator
Novi, MIchigan 03/2016 - Current
  • Supervise and maintain all quality, utilization, and HEDIS documentation for 4 providers.
  • Develop monthly reports of data done with MS Access to stay on track with quarterly/ yearly office targets.
  • Evaluate medical guidelines and benefit coverage to determine appropriateness of services.
  • Successfully juggled multiple projects simultaneously to aid patient satisfaction and keep office running smoothly and effectively.
  • Certified Care Manager serving all eligible patients presenting with Complex Medical Conditions or in need of services.
  • Keep patients, parents, and colleagues up-to-date on latest healthcare knowledge.
  • Utilized proven problem-solving methods in accordance with company policy to enhance client satisfaction.
  • Represent office during physician organization (PO) and community meetings, delivering supporting information and announcing new facility programs and initiative methods.
  • Maintain affective communication/ interaction with all cultures and age groups.
  • Supervise, recruiting, hiring and training of all staff, providing direct supervision, ongoing staff development and continuing education to employees.
  • Developed and updated policies and procedures maintaining compliance to PCMH, HIPPA, and state/ local/ federal guidelines.
  • Managed quality assurance program, including on-site evaluations, internal audits and customer surveys.
Trinity Health Corporation - Healthcare Administrative Intern
Livonia , Michigan 09/2019 - 12/2019
  • Editor and advisor for 900+ page document submission of the Pathway to Excellence Certification through the ANCC for Trinity Health PACE. (Document was accepted in January 2020)
  • Created Pathway Education Booklet to educate information represented in document and recognize the hard work of staff members at all East Coast and Mid-West PACE sites.
  • Project management rollout of Trip Master and Policy Tech.
  • Organized and monitored medical education training programs for new staff and collected data to track performance and efficiency.
  • Supported project managers in managing schedules and milestones.
  • Tracked project performance to analyze successful completion of short- and long-term goals.
  • Did extensive process mapping through Visio to keep projects organized.
  • Attended daily meetings with executive leaders from across country.
  • Created and edited presentations for senior leaders used for weekly huddles.
Green Tree Pediatrics - Healthcare Administrative Intern
Chelsea And Ann Arbor , Michigan 01/2019 - 05/2019
  • Incorporating new and enhancing already used processes to meet insurance quality improvement measures to hit incentive targets. (Closed 150+ gaps in 5 months)
  • Updating administrative policies and procedures for front office staff and nursing staff.
  • Creating/ incorporating patient registry to keep track of care patients receive and close any gaps patients might have to maintain quality care.
  • Administrative meetings with all contracted insurance companies to gain knowledge of value based incentive programs offered and presenting to in-office physicians to keep them up-to-date.
  • Modified office/ patient workflow to improve patient experience.
  • Project manager in roll-out of digital, contact free, patient sign in.
  • Made sure all trainings / updates made were consistent and maintained at both offices.
  • Collaboration of rural and urban settings.
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Resume Overview

Companies Worked For:

  • Twelve Oaks Pediatrics PLLC
  • Trinity Health Corporation
  • Green Tree Pediatrics

School Attended

  • Oklahoma State University
  • Madonna University

Job Titles Held:

  • Quality/Utilization Administrator
  • Healthcare Administrative Intern

Degrees

  • MBA : Healthcare Administration
    Bachelor of Science : Health Services Administration

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