Beryl Powell
Quality improvement Specialist
Humble,Texas
Summary
Managed Care background with 6+ years of HEDIS experience Excellent interpersonal, HEDIS Measures Ciox, Computer proficient with EMR, HIPAA, Kofax, Amysis, Microsoft Outlook, and Excel, typing 50+WPM Experienced Quality Improvement Coordinator offering 6-year career history of successfully creating and implementing improvement plans for policies, plans and guidelines. Highly accurate, productive and goal-driven with excellent skills in verbal and written communication, decision making and resource coordination. Passionate about maximizing patient care standards in Healthcare environments. Physically fit and mentally sharp professional with 15 years of healthcare experience.
Overview
9
9
years of professional experience
5
5
years of post-secondary education
Work History
Quality Improvement Specialist
Centene/Healthcare Support
Maitland, FL
11.2022 - 05.2023
- Checked patient conditions and records to evaluate care.
- Evaluated competency of clinical staff, documenting performance measures and recommending improvements.
- Documented and reported issues with compliance, standards of care and quality assurance requirements.
- Reporting HEDIS abstraction, and audit medical records a
- Maintain data collection of facilities, providers locations, NPI, and Tax ID numbers
- Assist iin investigation and resolution of member quality of care complaints
Authorization/Medical Referral Specialist
Centene/Healthcare Support
Maitland, FL
11.2022 - 05.2023
- Self-motivated, with a strong sense of personal responsibility.
- Preapprove specific medical services for patients
- Support and process authorizations for clinical staff in the Utilization departments
- Process 40 authorizations a day.
- Verify Medical insurance, Commerical, Medicaid, Medicare, Foster Care
- Attached clinicals to patient's authorizations
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
- Review patient's medical history
- Contact admit physicians as needed
- Input new patient information and update information in Citrix, Faxcom, Filenet, Decision Tree, TruCare Cloud
Insurance Authorization Specialist
Lucid Lane
Los Altos, CA
06.2022 - 09.2022
- Follow up with providers 65+ calls daily for missing or incomplete information
- Scheduled medical records charts review for HEDIS
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Updated metrics/benchmarks for each measure
HEDIS Coordinator
Anthem BCBS/Judge Group
San Antonio, TX
01.2022 - 05.2022
- Entered data, generated reports, and produced tracking documents.
- Gathered and organized measures for HBP, Diabetes, well baby, Adult Well check, Immunizations,
- Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
- Tracked records, filed medical documents and maintained communication between clients
- Faxed and scanned medical records and uploaded to the EMR system
- Follow-up Calls to providers offices, fax letters to providers and patients.
- Ensure medical records are label correctly
- Maintain HIPPA, and follow policy and procedures for HEDIS
Patient Support Service Representative
Healthcare Support/ Conifer Health
Maitland, FL
04.2021 - 08.2021
- Furthered skills by actively taking part in employee training and taking classes to improve skills.
- Conduct front end revenue cycle duties
- Appointment scheduling to facilitate the patient visit
- Uploaded over 75 Claims submission, and mailed 70 claims to insurance carriers
- Upload claims to Medicaid, BCBS, Availity, and Humana portals
- Generate reports and assist with department correspondence
- Check (Coordination of Benefits)COB information
Benefits Specialist
Veterans Evaluation Services/Addison Group
Houston, TX
06.2020 - 08.2020
- Resolved issues and inquiries from plan participants regarding health and deductions through telephone, email.
- Process request for medical records,
- Follow up with managed care, commerical, worker's compensation , companies to verify eligibility
- Mailed and submitted a hard copy 1500 forms, EOBs UB92, and itemized statements to medical facilitie
- Maintained confidentiality of all employee information.
- Developed and managed personal book of business with 50 clients per day.
Long-Term Substitute Teacher
Responsive Ed / Humble Classical Academy
Humble, TX
2019.10 - 2020.06
- Maintained day-to-day classroom management and discipline to promote learning initiatives.
- Took over class for regular classroom teacher, managing assignments, student needs, and recordkeeping.
- Communicated with parents regarding lesson plans and upcoming activities and provided feedback on student performance.
- Followed classroom plans left by class teacher to continue student education and reinforce core concepts.
- Taught diverse subjects for grades K-5, successfully delivering seamless teaching in absence of regular teacher.
- Organized lesson plans using teaching software for long-term interim assignments.
- Prepared children for State Testing
- Adapted lesson plans and student activities to meet needs of students with special learning needs.
- Incorporated technology into learning to enhance student engagement and learning.
- Supervised lunchroom and recess activities.
- Kept accurate and current attendance records and assignment sheets to maintain file compliance.
- Monitored student progress and provided feedback to students, parents and school administrators.
- Developed and implemented engaging lesson plans to accommodate varied student learning styles.
- Collaborated with colleagues to develop innovative approaches to teaching.
- Worked in administrative office assisting with enrolling students, updating immunization forms, demographic information, identification, etc
Authorization Specialist
Bridgeway Center
Fort Walton Beach, FL
04.2014 - 09.2017
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Verified eligibility and compliance with authorization requirements for service providers.
- Credentialing for new providers, checking NPI, Tax IDS, NECOS, Education, previous employers, insurance verification, Violations, etc
Education
Data Analysis -online Certificate - undefined
Masters - Healthcare Management/Education
01.2009 - 11.2011
Bachelor of Arts - Healthcare Administration
08.2007 - 05.2009
Skills
- Coding Knowledge
- Competency Evaluations
- Patient Data Management Systems
- Quality Control Procedures
- Training Implementation
- Utilization Management
- Cause and Effect Analysis
- Statistic Analysis
- Six Sigma
- Customer Satisfaction
- Discharge Summaries
- Creative Thinking
- Corporate Compliance
- Training Coordination
- Reproductive Health
- Interdisciplinary Care
- Patient Safety
- Strategic Planning
- Policy Development
- Learning Techniques
- Utilization Review
- Health Needs Education
- Standard Operating Procedure
- Problem Resolution
- Educational Materials
- Change Control Procedures
- Urgent Care
- Facility Maintenance
- Nursing Diagnosis
- Patient Care Activities
- Team Meeting Management
- Glucose Testing
- Coding Knowledge
- Policy Updates
- Production Reports
- Patient Flow
- Total Patient Care
- Patient Admission
- Electronic Charting
- Special Events
- Interaction Monitoring
- Continuous Quality Improvement (CQI)
- Operational Procedures
- Facility Operations
- Staff Education
- Performance Improvement Monitoring
- Annual Evaluations
- Quality Control Data Analysis
- Quality Patient Care
- Documentation Management
- Patient Treatment
- Emotional Support
- Monitoring Outcomes
- Records Management Systems
- Regulatory Dossiers
- Treatment Options
- Physician Recruiting
- Microsoft Excel
- Performance Evaluations
- Invoice Statements
- Invasive Procedures
- Data Representation
- Software Languages
- Process Updates
- Coding Knowledge
- Quality Management Systems
- Raw Material Questionnaires
- Financial Management
- Management Expertise
- Data Review
- Audit Compliance
- Condition Diagnosis
- Training Initiatives
- Nursing Staff Management
- Analyze Test Results
- Healthcare Operations
- Community Resources
- MathWorks MATLAB
- New Testing Methodologies
- Production Monitoring and Assessment
- Medical Charts and Records
- Medication Administration
- Gauge and Sensor Calibration
- Laboratory Computer Systems
- Peer Review
- National Instruments LabVIEW
- Compliance Requirements
- Database Maintenance
Work Preference
Work Type
Full TimeWork Location
RemoteHybridOn-SiteImportant To Me
Company CultureCareer advancementHealthcare benefitsPaid time off4-day work weekFlexible work hoursWork from home optionWork-life balanceTimeline
Quality Improvement Specialist - Centene/Healthcare Support
11.2022 - 05.2023
Authorization/Medical Referral Specialist - Centene/Healthcare Support
11.2022 - 05.2023
Insurance Authorization Specialist - Lucid Lane
06.2022 - 09.2022
HEDIS Coordinator - Anthem BCBS/Judge Group
01.2022 - 05.2022
Patient Support Service Representative - Healthcare Support/ Conifer Health
04.2021 - 08.2021
Benefits Specialist - Veterans Evaluation Services/Addison Group
06.2020 - 08.2020
Long-Term Substitute Teacher - Responsive Ed / Humble Classical Academy
2019.10 - 2020.06
Authorization Specialist - Bridgeway Center
04.2014 - 09.2017
University of Phoenix - Masters, Healthcare Management/Education
01.2009 - 11.2011
University of Phoenix - Bachelor of Arts, Healthcare Administration
08.2007 - 05.2009
- Data Analysis -online Certificate,
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