Quality Assurance Resume Profile

SUMMARY

Analyst with 15 years of experience in the Health Care Industry performing both front and back end tasks, working with EHR/EMR and clinical systems with providers, hospitals, and insurance companies. Knowledge of Systems Development Life Cycle SDLC and the implementation of Health Information Systems. Have HEDIS and clinical data experience with knowledge of clinical quality assurance on NCQA compliance and guidelines in quality of patient care. Detail oriented with great client and customer relations. Team oriented with the ability t manage projects independently.
Proactive Leader, Self-Starter, and Problem Solver
HEDIS/ Clinical Quality Management / Quality Assurance / Data Abstraction
Medical Records Review Validation MRRV / Reporting Analysis/ EHR EMR Systems
Financial Management Claims Payment Processes / Medical Billing Coding / Application Systems

CORE COMPETENCIES

KEY CAREER ACCOMPLISHMENTS

HEDIS/ Clinical Quality Management

Managed and participated in various rate improvement activities for assigned HEDIS projects in both Commercial and Medicare.
Performed initial and ongoing outreach t provider offices for follow-up on data collection.
Coordinated the rate collection efforts with the HEDIS Project Manager.
Initiated vendor system enhancements.
Abstracted medical record data for HEDIS measurements using EHR application. Telecommuter.

Claims/Financial Reporting Analysis

Coordinated departmental projects for ongoing internal compliance efforts identified through reporting and analysis.
Provided and achieved 100 on-time turnaround for report requests for ad-hoc, weekly, monthly, and quarterly basis t Executive and Management staff.
Maintained departments' PBS database for providing financial and claims data and reporting.

Systems Development:

Conducted design sessions for Medicaid Management Information System.
Worked with IBM Rational Tools in developing system documentation for developers.
Helped t define the flow of patient health information and system workflow processes.
Created and modified design documents, mock-ups for MMIS development team i.e., letters, reports, use cases, and interfaces . Telecommute/ some travel was required.

Application Support:

Provided technical assistance t end-users on system functionality.
Provided computer and application support on various systems.
Trained staff on system applications in support of maintaining, storing and retrieving health information.

Health Information Management

Worked in the areas of maintenance, storage, and retrieval of patient health information for health providers, facilities, and insurance companies.
Worked in front-end t back-end processes utilizing EHR/EMR systems from patient care t revenue cycle processes.

EMPLOYMENT HISTORY

HEDIS/Clinical Quality Analyst Confidential

Confidential

Senior Systems Analyst Confidential

HEDIS Abstractor Confidential

Physician's Billing Systems Analyst Confidential

Senior Systems Analyst Confidential

Billing Analyst Confidential

Medical Billing/Assistant Confidential