DEBORAH BIEN
Quality Management Professional
Greenbrier,Tennessee
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Summary
Dedicated quality management professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand with over 20 years of professional experience.
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.
Education
Associate of Arts - Healthcare Management
08.2020
Diploma - Nursing
Diploma -
Skills
- Clinical quality improvement
- Effective communication
- Episodes of Care programs
- Medical records review
- NCQA Health Plan Accreditation
- Operational planning
- Policy and procedure development
- Proficient in: MS tools, Cotiviti QR Web & Rapid, Salesforce, Tableau, SharePoint
- Quality programs: HEDIS, STARS, CAHPS, HOS, PIP
- Regulatory & contractual compliance
- Strategic planning
- Staff management
- Training and mentoring
- Value-based payment models
Affiliations
National Association for Healthcare Quality (NAHQ) Member
Certification
- Licensed Practical Nurse- 1994-Present
- Certified Professional in Healthcare Quality (CPHQ) Present
Timeline
Manager Clinical Quality - HEDIS, Anthem, Inc
01.2019 - Current
Clinical Program Development Manager - Amerigroup Tennessee, Inc
01.2016 - 01.2019
Nurse Clinical Quality/Compliance Administrator, Sr., Accreditation Manager - Amerigroup Florida, Inc
01.2014 - 01.2016
Quality Management Coordinator/Practice Consultant - Amerigroup, Medicare
01.2013 - 01.2014
Quality Management Coordinator - Amerigroup Tennessee
01.2011 - 01.2013
Partnership for Quality Coordinator/Coordinator Supervisor - HealthSpring of Tennessee
08.2007 - 01.2011
Southern New Hampshire University - Associate of Arts, Healthcare Management
Virginia Beach School of Practical Nursing - Diploma, Nursing
Largo Senior High School - Diploma,