DONNA MODRAS, RHIT
Troy,USA
Summary
Results-driven professional specializing in project management and data analysis to enhance Medicare Advantage star ratings. Managed vendor oversight and implemented quality improvement strategies to drive initiatives. Developed statements of work and fostered collaboration across teams to ensure healthcare compliance. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised.
Overview
1
1
Certification
45
45
years of professional experience
Work History
Lead II, Business analysis
Healthedge
Aliso Viejo, USA
09.2017 - Current
- Led/co-led Advantasure initiatives for multiple clients (MAPPO/BCNA/AK/NE/Premera/KS/Wellmark) including In-Home Test Kits, Colonoscopy Education, Provider Letters for Noncompliant COL Members, Breast Cancer Awareness, Quest Phase I Pilot, In-Home Quality Assessment, Controlling Blood Pressure Pilot, Medication Reconciliation Pilot, Member Incentives, Care Packages, Phone Outreach, and Q3 Engagement Mailer to enhance member health outcomes.
- Created and executed multiple initiatives to improve STAR ratings and enhance the health of the Medicare Advantage population.
- Submitted data analytic requests, managed supplemental data submissions, updated annual roadmaps for supplemental data, and prepared for HEDIS annual audit, streamlining data transfer processes between vendors and Advantasure.
- Work directly with vendor and vendor oversight contracting team on Statements of Work; First to create Master Statement of Work with separate Work Orders for multiple clients with Home Access
- Engaged with vendors through weekly meetings, monitoring progress and reporting for each initiative to ensure timely completion and quality deliverables.
- Manage multiple steps in the communications approval process with the operational communications team, client oversight team, member mailing/phone support, worked with various vendors including print/mail vendors
- Previously Tessellate, Advantasure, UST HealthProof
Senior Clinical Quality Consultant
MPRO
05.1991 - 09.2017
- Monitored progress and provided guidance to Michigan hospitals in CMS Hospital Quality Reporting Program to enhance quality metrics
- Conducted DRG Validation Review for hospitals as Review Operations Associate, collaborating with Coding and Data Integrity Panel at Michigan Health and Hospital Association and BCBSM
- Conducted quality audits to ensure compliance with industry standards.
- Developed training materials to educate staff on quality control processes.
- Collaborated with cross-functional teams to improve product quality.
Senior Coding Consultant
Medquist
Mount Laurel, USA
01.1999 - 01.2006
- Executed coding and audits for multiple hospitals in Metro Detroit area, ensuring compliance and accuracy in medical documentation.
- Developed coding protocols to ensure compliance with medical transcription standards.
- Analyzed client needs to provide tailored coding solutions for healthcare documentation.
- Collaborated with healthcare professionals to clarify complex medical terms and procedures.
Coding Technician
Healthcare Knowledge Resources (HKR)
Ann Arbor, USA
01.1990 - 01.1991
- Updated ICD-9-CM code books and encoder logic to ensure accuracy in coding practices
- Assisted customers with coding questions and concerns through hotline, providing timely resolutions to enhance customer satisfaction
Utilization Review Coordinator
Michigan
Farmington Hills, Michigan
07.1981 - 12.1990
- Coordinated utilization review processes to ensure compliance with healthcare regulations.
- Coordinated precertification and recertification processes for patient admissions and continued stays, facilitating timely service delivery.
- Evaluated patient eligibility for services based on IS/SI criteria and discharge screenings to ensure appropriate care access.
- Analyzed patient data to determine appropriate levels of care and services.
- Collaborated with medical staff to gather relevant clinical information for reviews.
Education
Associate Degree - Health Information Management
University of Detroit Mercy
Detroit, Michigan01-1981
Skills
- Data analysis
- Project management
- Vendor oversight
- Statement of work development
- Regulatory compliance
- Quality improvement strategies
- Microsoft Office Suite
- Attention to detail
Affiliations
- Member American Health Information Management Association
- Member Michigan Health Information Management Association
Certification
Current certification as registered Health information technician (RHIT)
Timeline
Lead II, Business analysis
Healthedge
09.2017 - Current
Senior Coding Consultant
Medquist
01.1999 - 01.2006
Senior Clinical Quality Consultant
MPRO
05.1991 - 09.2017
Coding Technician
Healthcare Knowledge Resources (HKR)
01.1990 - 01.1991
Utilization Review Coordinator
Michigan
07.1981 - 12.1990
Associate Degree - Health Information Management
University of Detroit Mercy