Claudia De Los Rios
Hollywood,FL
Summary
I have a proven track record of delivering high-quality care while maintaining patient safety and satisfaction Successful health information professional accomplished in maintaining complex and comprehensive records systems. Enhanced operations by identifying and recommending upgrades. Fully versed in medical terminology and code classifications. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth.
Overview
22
22
years of professional experience
1
1
Certification
Work History
HEDIS Field Reviewer
Hallandale Medical Center
Hallandale, FLORIDA
01.2019 - Current
- Identified potential areas of improvement in provider performance related to HEDIS measures.
- Gathered, evaluated and interpreted data from various sources to ensure accuracy.
- Monitored progress towards completion of assigned tasks within designated timeframes.
- Assessed the validity of submitted claims against applicable regulations and standards.
- Conducted comprehensive review of medical records for HEDIS compliance.
- Collaborated with other departments to ensure timely submission of required documents.
- Performed audits on a regular basis in order to assess adherence with applicable standards.
- Attended meetings with staff members to discuss best practices related to HEDIS measures.
- Documented observations, identified deficiencies, and provided recommendations for improvement.
- Reviewed medical records for completeness, accuracy, timeliness, and appropriateness of care.
- Attended meetings and webinars related to Health Plan Quality Improvement initiatives.
- Performed HEDIS data collection and abstraction from medical records for multiple health plans.
Medical Biller and Coder
Hallandale Medical Center
Halladale , FLORIDA
11.2015 - 01.2019
- Filed and submitted insurance claims.
- Assessed medical codes on patient records for accuracy.
- Documented and filed patient data and medical records.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Reviewed medical records to meet insurance company requirements.
- Performed routine quality assurance audits to promote data integrity.
Research Assistant
Texas Tech
El Paso, TX
12.2009 - 07.2012
- Conducted surveys, interviews and experimental research to facilitate data analysis.
- Verified accuracy of data by conducting quality assurance checks on collected materials.
Primary Care Physician
Suramericana Insurance
Cali, Colombia
01.2002 - 08.2009
- Managed chronic conditions such as diabetes or hypertension by providing ongoing monitoring and support services.
- Reviewed diagnostic imaging studies such as x-rays, MRIs, CT scans prior to making a diagnosis.
- Provided education to patients regarding their health care needs and preventive measures.
- Maintained accurate electronic medical records of all patient visits, treatments, and outcomes.
- Performed minor surgical procedures such as suturing wounds or removing moles or skin tags.
- Prescribed medications as needed while ensuring safety precautions were followed according to established guidelines.
- Conducted physical exams and interpreted test results to diagnose illnesses or injuries.
Education
Associated Degree in Nursing (ARN) -
International Institute for Healthcare Professionals
01.2023
Skills
- Patient assessment and care planning
- Medication administration and dosage calculation
- Effective communication with patients and healthcare teams
- Proficiency in electronic health records (EHR/EMR)
- Knowledge of infection control and safety protocols
- Strong commitment to ethical and evidence-based nursing practice
- Medical Coding
- Data Collection
- Quality Improvement
- Clinical Documentation
- HIPAA Compliance
- Quality improvement initiatives
- HIPAA knowledge
- Healthcare management
- Patient Care Coordination
- Decision-Making
- Analytical Thinking
- Teamwork and Collaboration
- Electronic Medical Record Software
- Task Prioritization
- Organizational Skills
Certification
- Basic Life Support (BLS) Certification since 2022
- ACLS Certification-Current
License
Registered Nurse (RN) License, Florida- current
Leadership Experience
I received the "Outstanding Nursing Student" award during my time in nursing school, and I have been recognized for my contributions to patient safety and satisfaction in my current role.
Communication Skills
I have received several awards for my outstanding communication skills, including recognition for providing exceptional patient education and counseling.
References
Available upon request
Timeline
HEDIS Field Reviewer
Hallandale Medical Center
01.2019 - Current
Medical Biller and Coder
Hallandale Medical Center
11.2015 - 01.2019
Research Assistant
Texas Tech
12.2009 - 07.2012
Primary Care Physician
Suramericana Insurance
01.2002 - 08.2009
Associated Degree in Nursing (ARN) -
International Institute for Healthcare Professionals
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