Britnie Sorensen
Portland
Summary
Dynamic professional with a proven track record of enhancing quality standards, achieving 4+ Stars in Medicare Advantage, and significantly increasing coding accuracy. Expertise in strategic design and stakeholder engagement drives collaborative partnerships that implement successful coding initiatives. Committed to operational excellence and market expansion, empowering teams to consistently exceed performance metrics. Skilled program director adept at managing all facets of program operations, including administration and outreach. Well-versed in multitasking to achieve challenging goals. Prepared to leverage several years' experience the field to take on challenging role.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Program Director, Quality Incentive Programs
Cambia Health Solutions
Portland
01.2024 - Current
- Program Director responsible for design, implementation, and daily operational support of primary care providers incentive programs for non-profit health plan across Oregon, Washington, Idaho and Utah
- Incentive program for Medicare Advantage and ACA lines of business, with expansion for Federal Employee Program being developed
- Reestablished operational process and procedure to ensure consistent support for providers and internal teams
- Responsible for restructuring incentive program to support Stars and Risk Adjustment performance
- Accountable for ensuring incentive program structure aligned with ROI for business stakeholders
- Oversight of 20 million program budget
Assoc Director Clinical Quality, Quality Field Organization
Optum
Boise
01.2021 - 12.2023
- Market director supporting 262k Medicare Advantage lives across Idaho, Nevada, Montana, and Utah, led a team of 13 individuals, set team direction, ensured performance metrics were met and exceeded based upon quality standards and business needs
- Expanded markets by 10%, on target for continued growth
- YoY maintained and improved STAR ratings for 83% of accountable membership (goal 4 STAR)
- Successful HEDIS and RAF chart collection across market, 100% of records collected
- Accountable for over 1b in Revenue each year
Manager Clinical Quality, Quality Field Organization
Optum
Boise
01.2020 - 12.2021
- Led and supervised field-based staff, supporting HEDIS gap closure and Risk Adjustment coding accuracy for Medicare Advantage members
- Achieved 4.5 Stars for SY2022, on target to achieve similar ratings SY2023
- Expanded Idaho market by 20%, on target for continued growth
Network Program Manager - Medicare Consultant
Optum
Boise
01.2018 - 12.2020
- Supported risk adjustment coding efforts for provider clients, worked as a team to achieve yearly goals, interacted with operational and clinical leadership to support best practice of assessing chronic conditions and accurately documented and applied appropriate ICD-10-CM codes
- Supported team members with ensuring providers understood the use of CPT II coding for CMS Medicare Advantage Star Ratings
- Supported Idaho, Utah, and Nevada provider groups coding accuracy and documentation efforts for HEDIS
- Created content and presented on National Telehealth best practices webinar
Risk Adjustment Coding Quality Analyst
Optum Care
West Valley City
01.2015 - 12.2018
- Performed quality audits on physician documentation to support Care Delivery Risk Adjustment Payment System, identified issues and trends in coding and documentation that affected risk adjustment factor scores, assisted in capturing needed HEDIS and Quality initiatives, taught physician and support staff HCC coding
Outpatient Physician Coder 2
University Medical Billing
Salt Lake City
01.2014 - 12.2015
- Code CPT and ICD-9-CM and ICD-10-CM for multiple specialties, provide education to physician regarding documentation improvements, check accuracy of coding done by other coders and provide feedback
- Educate physicians on documentation improvements for CPT and ICD-10-CM coding, for E/M and procedural notes
Senior Business Analyst
Optum Insight
Salt Lake City
01.2007 - 12.2014
- Collected business requirements from internal and external clients and defined requirements for proprietary medical claims editing software (Medicare, Medicaid, Commercials, Fraud, Waste and Abuse)
- Analyzed client issues and provided solutions and contributed to end user acceptance testing
- Led project teams in the US and India to achieve critical product development goals
- Used Scrum, Waterfall and Agile methodologies during entire software development lifecycle
Education
Coursework - Accounting
Westminster College
Salt Lake City, UTSkills
- Fostering Positive Motivation
- Facilitating Passionate Growth
- Project Leadership
- Implementation of Coding Accuracy Initiatives
- Healthcare Quality Improvements
- Auditing and Educating for Coding Accuracy and Quality Documentation
- Develop Collaborative Partnerships
- Strategic Design Development
- Stakeholder engagement
- Project coordination
- Effective communication
- Market expansion
- Coaching and mentoring
- Teamwork and collaboration
- Strategic planning
- Content development
Affiliations
AAPC, 2005
Certification
- CRC, Certified Risk Adjustment Coder, 2018
- CPC, Certified Professional Coder, 2005
- COC, Certified Hospital Outpatient Coder, 2008
Community Service
- Family Readiness Group Treasurer, Utah Army National Guard, 01/01/10, 12/31/12
- Local Chapter Officer (Treasurer, President, Vice President), AAPC, 01/01/16, 12/31/21
References
References available upon request.
Timeline
Program Director, Quality Incentive Programs
Cambia Health Solutions
01.2024 - Current
Assoc Director Clinical Quality, Quality Field Organization
Optum
01.2021 - 12.2023
Manager Clinical Quality, Quality Field Organization
Optum
01.2020 - 12.2021
Network Program Manager - Medicare Consultant
Optum
01.2018 - 12.2020
Risk Adjustment Coding Quality Analyst
Optum Care
01.2015 - 12.2018
Outpatient Physician Coder 2
University Medical Billing
01.2014 - 12.2015
Senior Business Analyst
Optum Insight
01.2007 - 12.2014
Coursework - Accounting
Westminster College
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