DEBORAH BIEN

Work History

Manager Clinical Quality

HEDIS, Anthem, Inc

Nashville, Tennessee

01.2019 - Current

Recruited and hired top-performing individuals bringing undeniable experience and wealth of skills to organization.
Manage activities for HEDIS and STARS Medicare clinical quality program including abstraction, research and medical record collection.
Assisted with database upgrades and migrations by performing user acceptance testing.
Implement and evaluate processes including operational statistics, service standards, and process improvement CQI activities
Provide oversight in the planning, implementation, and coordination of processes related to the pursuit, research, and abstraction of medical records
Participates in internal and external quality review including but not limited to medical record validation for final HEDIS rates
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Collected, reviewed and analyzed data from diverse departments for CQI needs.
Trained staff on technical procedures and software program usage.
Designed, deployed, validated and finalized database systems for medical record collection and abstraction/research operations.
Built and deployed plans, reports, validation procedures and entry processes for data management needs.
Wrote work instruction manuals, data capture guidelines and standard operating procedures.
Developed and implemented performance improvement strategies and plans to promote continuous improvement.

Clinical Program Development Manager

Amerigroup Tennessee, Inc

Nashville, TN

01.2016 - 01.2019

Responsible for managing, implementing, and ongoing clinical support for the Provider Relations
Innovation Team regarding Payment innovations
Provides leadership and guidance to associates involved in program implementation activities
Serves as the point of contact for providers to educate on all Health Plan quality improvement programs, clinical coordination, process improvement evaluation, and implementation
Collaborates with stakeholders on program design, review, and program improvement implementation
Serves as a liaison with state provider contracting account managers and other associates
Identifies industry best practice standards and other resources to drive clinical program development that supports quality, cost-effective care
Develops, implements, and leads program reporting activities.

Nurse Clinical Quality/Compliance Administrator, Sr., Accreditation Manager

Amerigroup Florida, Inc

01.2014 - 01.2016

Responsible for leading Quality Management (QM) activities to ensure all departments meet accreditation and regulatory standards
Designated Risk Manager worked with AHCA to ensure compliance with Quality focused contractual requirements
Prepared health plan for accreditation submission and reviews
Served as the SME for applicable accreditation standards, developed tools that assist in determining exposure to accreditation risks, and identified opportunities to manage and mitigate those risks
Developed and maintained all required annual Quality Program Documents
Provided primary support for all quality committee activities including quarterly reporting on the Health
Plan’s quality activities to the Quality Committee, Board of Directors, and Medical Advisory Committee
Participated in the budget process as needed
Prepared QM Department for oversight audits
Prepared corrective action plans
Conducted audits of QM processes and files, wrote policies and procedures, and assisted with the development of provider/member manuals, audit tools, and guidelines to ensure compliance
HEDIS program focused on performance improvement, and medical record collection strategies for implementation.

Quality Management Coordinator/Practice Consultant

Amerigroup, Medicare

01.2013 - 01.2014

Worked to develop and implement clinical quality initiatives with our Tennessee Medicare Providers
Evaluated intervention effectiveness for STAR/HEDIS performance, and developed educational materials, presentations, and strategies to promote continuous improvement of STAR/HEDIS scores
Worked closely with providers and internal stakeholders to establish effective communication as well as to provide continuing education programs regarding STAR/HEDIS initiatives
Led HEDIS Medicare annual Hybrid project working closely with Health Plan leadership.

Quality Management Coordinator

Amerigroup Tennessee

01.2011 - 01.2013

Responsible in conjunction with management for developing, coordinating, implementing, and evaluating the continuous quality improvement activities throughout the health plan with a primary focus on HEDIS,
Accreditation, and state regulatory activities.

Partnership for Quality Coordinator/Coordinator Supervisor

HealthSpring of Tennessee

08.2007 - 01.2011

Performed HEDIS data collection projects and education related to coding and documentation following
CMS and HEDIS guidelines/specifications
Scheduled and coordinated medical record reviews and on-site audits
Performed QA audits of Practice
Coordinator data collection to ensure adherence to CMS and HEDIS guidelines
Established key working relationships between physician partners, various internal departments, and stakeholders
Developed educational material for ongoing training and policy and procedures to guide our department processes and maintain compliance
Managed seven Practice Coordinators trained and evaluated performance, coached, and maintained payroll/HR activities
Successfully set up the model for the first independent IPA (Independent Practice Association) of physicians for our P4Q program
Provider education concerning process with coordination between practice, health plan programs, disease management, and case management.

Summary

Work History

Manager Clinical Quality

Clinical Program Development Manager

Nurse Clinical Quality/Compliance Administrator, Sr., Accreditation Manager

Quality Management Coordinator/Practice Consultant

Quality Management Coordinator

Partnership for Quality Coordinator/Coordinator Supervisor

Education

Associate of Arts - Healthcare Management

Diploma - Nursing

Diploma -

Skills

Affiliations

Certification

Timeline

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