Quality/Utilization Administrator Resume Example
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QUALITY/UTILIZATION ADMINISTRATOR
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 UniversityCity, StateExpected in 05/2022MBA: Healthcare Administration
- Minor Global Health
Madonna UniversityCity, State12/2019Bachelor 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
Atlantic Health System- Quality/Utilization Administrator
Oakland , NJ03/2016 - Current
Oakland , NJ03/2016 - 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.
Atlantic Health System- Healthcare Administrative Intern
Pompton Lakes , NJ09/2019 - 12/2019
Pompton Lakes , NJ09/2019 - 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
City , STATE01/2019 - 05/2019
City , STATE01/2019 - 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
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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