Ashley Thomas
Murrieta,CA
Summary
Talented professional considered knowledgeable leader and dedicated problem solver. Brings 20 years of valuable expertise to forward company objectives. Attentive to detail with experience in coordinating projects, programs and improvements. Expert in program management HEDIS and CMS measures. Willing to provide expertise training and communication.
Overview
19
19
years of professional experience
Work History
Program Manager- HEDIS Central
Cigna Group
05.2022 - 11.2023
- Tracking and reporting on incoming records received through year-round retrieval, loads into supplemental source HEDIS and stars documentation
- MRR operations and supplemental data integration
- Provides training programs to improve quality, control budget, ensuring compliance with state and federal regulations
- Collaborate with health plan leaders regarding provider experiences
- Collaborate with customers to analyze and transform needs and goals
- Develop, defines and execute business plans
- Monitors programs from initiation through delivery
- Attend CMS and industry meetings for relevant teachings and learnings for clients
- Ensures all trainings, job aids, and documentation are up to date accurate and compliant
- Provides training on updated and new system implementation
- Responsible for HEDIS program management, collaborating with cross-functional teams
- Reeducate and retrain staff when deficiencies are identified in performance
- Lead preparation and creation of HEDIS measure job aides, guides, process ensuring all documentation is standard for all team members
- Staying up-to-date and educating staff and leadership on upcoming NCQA proposed programmatic and measure-level changes and identifying opportunities for readiness.
- Managed and supervised administrative and daily program operations, complying with policies and regulations.
- Established strong relationships with key stakeholders, ensuring support for program initiatives.
- Met with project stakeholders on regular basis to assess progress and make adjustments.
- Built teams to address project goals and objectives for multiple projects.
- Delivered high-quality results by setting performance metrics and monitoring progress against targets.
- Improved program efficiency by streamlining processes and implementing time-saving solutions.
- Recruited, interviewed, hired and trained employees and implemented mentoring program to promote positive feedback and engagement.
- Managed multiple strategic projects with numerous sub-projects or workstreams.
- Developed strategic plans, setting clear objectives and achievable milestones for team members.
Regional Supervisor
Universal Healthcare Systems
01.2021 - 05.2022
- Manage daily workflow for 5 medical records departments
- Oversaw recruitment process to ensure hiring of top talent in alignment with company objectives.
- Analyzed market trends to identify new growth opportunities for business expansion within region.
- Adjust work assignments to cover peak periods
- Safeguard patient records in compliance of HIPAA
- Recruit, Hire, and onboard new employees
- Corrective action plans for employee development
- Update and SOP at all sites
- Generate daily, weekly, monthly reports
- Manage patient healthcare records
- Accept and process legal and criminal subpoenas
- Provide quality assurance monitoring of work performance
- Conducts productivity and work performance reviews
- Manage all escalations
- Participate in all meetings with HIM
- Maintained compliance with company policies, objectives, and communication goals.
- Training and development for all employees
- Production of CMS audit/RAC audit/TISTA audit
- Weekly facility TAT reporting
- DRG claims
- UB medical claims
- Lead HEDIS team in preparation for upcoming seasons
- Train all staff and contractors on policies and procedures for HEDIS project.
Medical Records Manager
Vista Community Clinic
01.2020 - 01.2021
- Assisted in the transition from paper-based records to digital formats, resulting in improved efficiency within the department.
- Established a centralized database for all patient information, facilitating easier access for healthcare providers across different departments.
- Managed a team of 5 medical records clerks, providing guidance on their daily tasks and ensuring timely completion of projects.
- Created standard operating procedures to maintain consistency in record-keeping practices throughout the organization.
- Developed performance metrics to evaluate staff productivity, providing feedback and guidance on areas requiring improvement.
- Scheduled and conducted educational programs to explain and discuss documentation policies and practices.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Monitors employee performance
- Developed policies and procedures to guide the collection, storage, and disposal of confidential health records in accordance with industry standards.
- Conducted staff training programs on proper documentation procedures, leading to a reduction in record discrepancies.
- Create workflows
- Create new policies and procedures
- Train staff on HEDIS Measures for current project
- Create job aides for HEDIS Season and update current aides to standards
- Work with leadership teams for development and implementation on trainings.
Clinical Operations Manager
Camp Pendleton Naval Hospital
10.2015 - 03.2017
- Oversite of daily duties and administration
- Recruited trained, and mentored new employees, fostering their professional development within organization.
- Oversaw daily operations of clinic, including staff scheduling, patient flow management, and facility maintenance.
- Conducted performance evaluations for staff members, identifying strengths as well as areas for growth and improvement opportunities.
- Ensured regulatory compliance with timely audits, thorough documentation, and prompt corrective actions.
- Initiated HIPPA/OSHA/JCAHO related compliance policies and procedures
- Managed 40 employees with various personalities and from different cultures for large 25 physician clinic.
- Manage daily assignments of clinic employees
- Oversee clinic accounting and budgeting
- Implemented onboarding for new employees, which enabled each to effectively learn tasks and job duties.
- Implemented new policies and educated staff on changes.
- Maintained clinic's records and files, utilizing proper techniques to keep patient data confidential.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Monitor patient flow and satisfaction
- Access CHCS/AHLTA
- Oversee staff projects/work for completion and accuracy
- Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
- Create and implement policies and procedures
- Coordinated multidisciplinary team meetings to discuss complex cases and devise individualized treatment plans for patients.
- Developed strategic partnerships with external stakeholders such as pharmaceutical companies or other healthcare providers to expand services offered.
Office Manager
Pasadena Gastroenterology
07.2004 - 07.2015
- Effectively displays and provides leadership to staff
- Manages day-to-day operations of physician office
- Manages physician schedules for multiple locations
- Abides by and promotes HIPAA compliance
- Covered medical records, front and back-office duties
- Supervise daily activities, maintained daily operations of office
- Coached new hires on company processes while managing employees to achieve maximum production.
- Submit authorizations.
- Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Coordinated special projects and managed schedules.
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Murrieta, Ca10.2019
MBA - Business Administration And Management
University of Phoenix
Murrieta, CA01.2021
Black Belt -
Lean Six Sigma
Murrieta, CA02.2024
Black belt Champion -
Lean Six Sigma
Murrieta, CA04.2024
Lean process -
Project Management Cert
Murrieta, CA02.2024
Certificate -
Executive Management Certification
Murrieta, CA02.2024
Skills
- Remote Team Management
- Healthcare
- Operations
- Finance
- Strategic Planning
- Compliance
- HEDIS/ CMS
- Program Management
- Star ratings
- NCQA measures
- QNXT
Personal Information
Title: Healthcare Program Manager
Timeline
Program Manager- HEDIS Central
Cigna Group
05.2022 - 11.2023
Regional Supervisor
Universal Healthcare Systems
01.2021 - 05.2022
Medical Records Manager
Vista Community Clinic
01.2020 - 01.2021
Clinical Operations Manager
Camp Pendleton Naval Hospital
10.2015 - 03.2017
Office Manager
Pasadena Gastroenterology
07.2004 - 07.2015
Bachelor of Science - Healthcare Administration
University of Phoenix
MBA - Business Administration And Management
University of Phoenix
Black Belt -
Lean Six Sigma
Black belt Champion -
Lean Six Sigma
Lean process -
Project Management Cert
Certificate -
Executive Management Certification
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