Summary
Overview
Work History
Education
Skills
Personal Information
Technology Experience
Languages
Timeline
Generic

AMY MARTINEZ, LPN

New Port Richey,FL

Summary

Self-motivated LPN brings proven leadership, organizational and customer relations skills. Independently solves problems and keeps teams on task to handle diverse business requirements. History retaining clients and talented staff.

Excellent verbal and written communication skills in English and Spanish. Presentation Skills and Highly organized, detail oriented, motivated, reliable and adaptable with a Positive Attitude.

Proven Experience in Customer Service, Sales, Marketing, Recruiting, Training, & Supervisory roles

Excellent Inbound/Outbound Phone Etiquette/Call Center Experience and Experience with Medical Terminology/ Data Input/ EHR Systems/ MRR/ Chart Abstraction and Data Mining.

Ability to work independently without close supervision.

Team Player, Open to diverse perspectives, and Trustworthy with a high level of Integrity.

Over 10 years experience in Healthcare Industry and Over 20 years experience in Consumer Relations / Sales and Service.

Self-motivated LPN brings proven leadership, organizational and customer relations skills. Independently solves problems and keeps teams on task to handle diverse business requirements. History retaining clients and talented staff.

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

26
26
years of professional experience

Work History

HEDIS Specialist/ Executive Assistant/ BSL

United HealthGroup, WellMed/Optum
04.2020 - 03.2025
  • Work in marketing, communications, compliance, quality, education to effectively accomplish project objectives and milestones in a timely manner, collaborating with Project Managers and other departments
  • Yearly HEDIS Training for Abstraction and Overreading on all HEDIS/Quality measures
  • Abstraction of charts for specific measures (pediatric, maternal health, transitions of care)
  • Assists in the development and management of tools to track quality objectives and project goals for each Quality Pillar
  • Support and ensure performance requirements for ad hoc Quality projects, Q4 and HEDIS preparation
  • Develop Standard Operating Procedures (SOP) on policies when needed for HEDIS Quality
  • Work well with deadlines and have keen attention to detail to maintain workflow and project timelines for HEDIS Quality

HEDIS Coordinator/Chart Abstractor

Healthcare Star Elements
07.2017 - 12.2019
  • Identify potential resources and initiate collaboration with Providers to improve member health outcomes and HEDIS standards, regulations, and measures
  • Conduct HEDIS provider chart request calls/mailings and/or faxes
  • Ensure referrals are addressed in a timely manner & Provide follow up with members/families
  • Act as a liaison and member advocate between member/family, physician, & facilities/agencies
  • Seek to resolve any concerns about care delivery or providers
  • Contact Physician offices as needed to obtain or update demographic information or related data
  • Be the system navigator and point of contact for members and families to have direct access for asking questions and raising concerns & developing and maintaining positive customer relations
  • Research and compile data / case findings
  • Input Data into Medical record Disease Index and/or Master Patient Index
  • Perform timely chart abstraction of assigned cases & Maintain 95% or higher abstraction accuracy (50 + charts daily)
  • Negotiating contracts with hospitals, physician groups, and other providers to participate in provider network demonstrating knowledge of best practices and conflict resolution

Health Information Management Specialist /Account Manager

HPH Hospice, Chapters Health Systems
06.2015 - 01.2016
  • Review admission documentation, ensure compliance with CQI Plans
  • Experience working with Hospitals/ Nursing Home Facilities/ Hospice Facilities/ Ancillary Service
  • Ensures compliance with all patient care /Assists in maintaining federal and state regulatory compliance
  • Maintain a proactive approach to managing potential issues, work to enhance communications
  • Initiate and manage clinical referrals for pre-authorization and review for completeness
  • Data Entry of patient information in Master Patient Index utilizing multiple computer systems
  • EHR - Data entry medical records and ICD classification for billing
  • Meet Quality & Production standards & Maintain HIPAA standards and Confidentiality
  • Servicing providers with exposure to benefits and contract interpretation
  • Experience with various healthcare entities, collaborating with network reps in various markets
  • Planning and Performance Management
  • Analytical skills and knowledge of Healthcare delivery/ Medicaid/ Medicare
  • Work independently and complete assignments without established procedures

Personal Care Assistant (PCA), Home Health CNA

Alvarez and Suarez Support
04.2009 - 03.2015
  • Company Overview: Managed Care
  • Experience in patient hospital discharge planning/ Admissions and discharges for SNF’s, Rehab
  • Keep accurate records of patient’s medical information and treatment history
  • Effectively manage coordination or care between Primary Care Physician, Specialists, and non-medical providers as necessary to ensure medical and socioeconomic needs of patients are met
  • Review progress notes and assessments; report on patient status to hospitals, PCP and case managers
  • Conduct comprehensive reviews and assessments with Case Managers/Coordinators to ensure medical necessity and appropriate level of care for patients and to resolve gaps in care
  • Promote patient and family education while developing, assessing, and adjusting patient care plan to promote optimal outcomes for mentally and/or physically disabled members
  • Identify potential resources and initiate collaboration with Providers to improve member health outcomes and Quality Assurance standards and provider performance in Risk/P4Q and Health Benefits Ration (HBR)


Sales Director/ Project Manager

International Sales Group, Inc.
01.2003 - 07.2008
  • Support sales strategies to meet company objectives & Exceed Sales Goals
  • Conduct sales training in order to promote broker business and increase performance
  • Emphasized Quality, Efficiency, and Outcome centered skills to promote focus and add value to our sales team and property environment
  • Develop Marketing and Sales Strategies for Planned development communities to include Ad Hoc- marketing programs and tracking effectiveness of local market campaign activities
  • Strong sales and negotiation skills/ Coordinating execution of multicultural marketing programs

Unit Secretary, Emergency Department

Tenet Healthcare, Hialeah Hospital
03.1999 - 04.2001
  • Order and Data entry utilizing multiple computer systems
  • Knowledge of ICD, Revenue codes, CPT/HCPC coding /Claims paying systems/Medical Terminology
  • Work with ED Team to expedite patient care & maintain JCAHO & HIPAA Standards
  • Responsible for admitting all ED patients & maintaining privacy & accurate account of patient information
  • Verified patients insurance policy, including deductible, out of pockets, and benefits
  • Serve as front line ambassador in customer service
  • Required skills in conflict resolution and critical thinking working in a fast paced environment

Education

Licensed Practical Nurse (LPN) -

Pinellas Technical College
St. Petersburg/Clearwater, FL

Bachelor of Science -

Florida International University
Miami, FL
08.2003

Skills

  • Relationship building
  • Data entry
  • Multitasking and organization
  • Work Planning and Prioritization
  • Strategic planning
  • Adaptability and flexibility
  • Document management
  • Customer service
  • Process improvement
  • Contract management
  • Project management

Personal Information

Title: Licensed Practical Nurse (LPN)

Florida License # PN5264584 


Technology Experience

  • MS Office – Excel, Word, Power Point, Outlook
  • Facets/Inovalon/Odis
  • Epic EHR Systems / Ellie Orlando Health
  • SharePoint
  • Quality Spectrum Hybrid Reporter (QSHR)
  • McKesson
  • Access / Visio / Adobe
  • EHR Applications
  • AppExtender Software Applications
  • WebEx/Teams
  • Ariba system/Concur System

Languages

English
Native or Bilingual
Spanish
Native or Bilingual

Timeline

HEDIS Specialist/ Executive Assistant/ BSL

United HealthGroup, WellMed/Optum
04.2020 - 03.2025

HEDIS Coordinator/Chart Abstractor

Healthcare Star Elements
07.2017 - 12.2019

Health Information Management Specialist /Account Manager

HPH Hospice, Chapters Health Systems
06.2015 - 01.2016

Personal Care Assistant (PCA), Home Health CNA

Alvarez and Suarez Support
04.2009 - 03.2015

Sales Director/ Project Manager

International Sales Group, Inc.
01.2003 - 07.2008

Unit Secretary, Emergency Department

Tenet Healthcare, Hialeah Hospital
03.1999 - 04.2001

Licensed Practical Nurse (LPN) -

Pinellas Technical College

Bachelor of Science -

Florida International University

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AMY MARTINEZ, LPN