Quality/Utilization Administrator Resume Example Twelve Oaks Pediatrics PLLC

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.

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

Quality/Utilization Administrator Resume Example

Resume Score: 80%

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