Chemberli Cline
Snellville,GA
Summary
Accomplished nursing professional with a focus on HEDIS compliance and quality measures. Demonstrates expertise in data abstraction and chart auditing, ensuring adherence to NCQA guidelines while fostering collaboration across clinical teams. Committed to ongoing quality improvement and patient education, enhancing overall healthcare delivery.
Overview
14
14
years of professional experience
1
1
Certification
Work History
HEDIS Abstractor-Nurse
BCforward
Indianapolis, Indiana
01.2026 - 04.2026
- Analyzed HEDIS measures to ensure compliance with quality standards
- Collaborated with clinical teams to review patient records, ensuring accurate data for HEDIS reporting
- Abstracted clinical information from various medical documents.
- Reviewed patient charts to ensure proper coding compliance.
- Collaborated with healthcare professionals to clarify documentation issues.
- Maintained up-to-date knowledge of coding guidelines and regulations.
- Assisted in quality assurance reviews to enhance data integrity.
- Performed quality control reviews on completed abstracts prior to submission.
- Cross-referenced records to ensure completeness and accuracy of abstracts.
- Facilitated communication between departments to streamline processes.
- Developed training materials for staff on quality improvement initiatives
- Identified discrepancies between recorded documents and current status of properties.
- Adhered to strict confidentiality protocols when handling sensitive client information.
- Compiled reports containing all the necessary details related to a particular document or set of documents.
- Utilized electronic health record systems to manage patient information efficiently.
Quality Review Overreader Nurse (Contract ended successfully)
Elevance/ Healthcare Support Agency
Atlanta, Ga
01.2021 - 05.2025
- Reviewed and validated charts abstracted for HEDIS measures, enhancing data integrity.
- Conducted chart reviews and audits of abstractions for HEDIS measures to ensure compliance and accuracy.
- Executed chart abstraction tasks for diverse hybrid and non-hybrid measures to ensure comprehensive data analysis.
- Monitored adherence to NCQA HEDIS abstraction and overread guidelines to maintain quality standards.
- Entered data into various EMR and database systems.
- Generated and submitted daily reports in Excel format to provide timely updates on findings.
- Engaged in quality meetings to discuss findings and contribute to continuous improvement initiatives.
- Completed extra quality projects and chart reviews upon manager's request.
Contingent Quality Analyst (Contract ended successfully)
UHG/CSI Company
06.2019 - 07.2020
- Executed chart abstraction for multiple hybrid and non-hybrid measures, supporting quality assessment
- Ensured that data entered by the initial Nurse Reviewer was compliant with NCQA HEDIS specifications
- Operated as remote HEDIS nurse, performing medical record analysis with EMRs to enhance data integrity
- Conducted over reads and audits of abstracted medical records to ensure accuracy and compliance
Quality Nurse Reviewer (HEDIS/ Contract ended successfully)
Anthem / Aerotek
12.2018 - 04.2019
- Collected and audited healthcare data to ensure compliance with NCQA, HEDIS, and company-specific quality measures.
- Flagged charts for SR team response and provided additional documentation to support review process.
- Input medical data into patient portal for accurate record-keeping.
- Researched medical claims to identify NPI (National Provider Identifier) for signing doctors.
HEDIS Nurse Consultant
Cigna / Quality Staffing
11.2015 - 04.2018
- Chart Abstractions for multiple HEDIS measures
- Ensured compliance of data entered by initial Nurse Reviewer with NCQA HEDIS Specifications, supporting quality assurance
- Reviewed abstracted data from initial Nurse Reviewer, ensuring consistency and accuracy
- Reviewed documents for Commercial department, enhancing accuracy of submissions
Review Nurse / Coder
Altegra Healthcare
01.2015 - 04.2017
- Guided coding, abstraction, and production processes while ensuring compliance with quality assurance standards
- Executed ICD 9 coding for in-patient and physician office claims
- Prospective & Retrospective Risk Adjustment Coding
- Monitored daily reports to ensure chart per hour count and QA requirements were met
Quality Management Nurse Consultant (Contract ended successfully)
Aetna / Managed Staffing
11.2014 - 04.2015
- Scheduled and confirmed site visit appointments for HEDIS reviews, ensuring timely onsite provider visits and abstraction.
- Locate and review ALL assigned medical charts, perform abstraction, copy all supporting
- Documentation per specifications and data enter into the applicable software system ALL assigned abstracts.
- Maintained onsite appointment schedule and coordinated calendar with team lead for efficient workflow.
- Conducted online data abstraction and entered required medical information into the software system.
- Complete assigned abstraction and data entry each day documents
Contingent HEDIS Review Nurse (Contract ended successfully)
Wellpoint / Judge Group
12.2013 - 11.2014
- Conducted medical chart reviews to ensure compliance with HEDIS guidelines
- Abstracted data from records for hybrid and non-hybrid measures to support quality assessment
- Chart review and abstraction of pertinent Medical data in accordance with various study criteria.
- Collected supplementary data from records to enable precise entry into HEDIS database.
- Data entry into the various data entry systems
- HIPAA and NCQA compliance maintenance on a daily basis.
HEDIS Review Nurse
Total Therapeutic management
12.2011 - 07.2013
- Conducted chart reviews and abstracted pertinent medical data per study criteria, enhancing overall research quality.
- Abstracted data from records for various Hybrid and Non-Hybrid measures, supporting accurate reporting.
- Reviewed medical charts to ensure compliance with study protocols, contributing to data integrity.
Education
Nursing Diploma - Practical Nursing
Georgia Piedmont Technical College
Clarkston, GA03-1996
Master's degree - Healthcare Administration
Ashford University
Clinton, IASkills
- HEDIS
- HEDIS abstraction
- Chart abstracting
- Quality assurance
- Clinical assessment
- Clinical documentation
- Data abstraction
- HEDIS compliance
- Care coordination
- Case management
- Patient assessments
- Chronic illness management
- Provider outreach
- Managed care
- NCQA
- Regulatory compliance
- Utilization management
- Prior authorization
- Claims processing
- Medical record processing
- Electronic medical records
- EMR systems
- ICD-10 data processing
- Medical records management
- Chart auditing
- Chart reviews
- Data entry and analysis
- data entry accuracy
- Quality reporting
- Patient education
- Nursing
- Nursing licensure
- HIPAA compliance
- HIPAA
- Microsoft Office
- effective communication
- problem solving
- critical thinking
- attention to detail
- Team collaboration
- Stakeholder collaboration
- Professional communication
- Medical records management
- Data entry and analysis
- Utilization criteria
- Professional communication
- Utilization management
- HIPAA compliance
- Medical documentation
Interview Availability
Fully Available, No Time off Requests
Certification
- Compact Nursing License
Affiliations
- HIV/AIDS activist, unhoused community service, horse groomer and therapy , youth groups, mentoring young women
Timeline
HEDIS Abstractor-Nurse
BCforward
01.2026 - 04.2026
Quality Review Overreader Nurse (Contract ended successfully)
Elevance/ Healthcare Support Agency
01.2021 - 05.2025
Contingent Quality Analyst (Contract ended successfully)
UHG/CSI Company
06.2019 - 07.2020
Quality Nurse Reviewer (HEDIS/ Contract ended successfully)
Anthem / Aerotek
12.2018 - 04.2019
HEDIS Nurse Consultant
Cigna / Quality Staffing
11.2015 - 04.2018
Review Nurse / Coder
Altegra Healthcare
01.2015 - 04.2017
Quality Management Nurse Consultant (Contract ended successfully)
Aetna / Managed Staffing
11.2014 - 04.2015
Contingent HEDIS Review Nurse (Contract ended successfully)
Wellpoint / Judge Group
12.2013 - 11.2014
HEDIS Review Nurse
Total Therapeutic management
12.2011 - 07.2013
Nursing Diploma - Practical Nursing
Georgia Piedmont Technical College
Master's degree - Healthcare Administration
Ashford University