Open To Work
Ericka Carter
Healthcare Specialist
Jacksonville,FL
Summary
Detail-oriented Healthcare Specialist with expertise in HEDIS reporting and ICD-10-CM coding, ensuring compliance and improving patient care quality. Experienced in managing EMR systems and executing member outreach to address care gaps. Collaborates effectively with healthcare providers to enhance documentation and optimize operations.
Overview
5
5
years of professional experience
3
3
Certification
Work History
HEDIS Specialist / MRA Coder
Island Doctors
04.2023 - 03.2026
- Conducted thorough reviews of medical records to extract clinical data for HEDIS Quality Metric Reporting.
- Conducted outreach to members with care gaps, ensuring adherence to HEDIS measures and promoting clinical compliance.
- Ensured accurate incorporation of internal and external data sources into HEDIS Stars programs by maintaining data capture and integrity.
- Trained healthcare staff on HEDIS compliance and best practices to enhance understanding and application.
- Facilitated access to clinical services, referrals, and medications for members.
- Confirmed essential screenings and services for members through coordination with providers.
- Reviewed patient medical records to assign accurate ICD-10-CM diagnosis codes, ensuring compliance with CMS regulations for Hierarchical Condition Category (HCC) coding.
- Analyzed documentation from primary care visits, both retrospectively and concurrently, to capture all relevant diagnoses.
- Work with physicians to improve documentation practices, ensuring, for example, that chronic conditions are addressed at least annually.
Office Specialist I
Baptist Endocrinology
10.2020 - 02.2023
- Greet and check in patients, and collect personal, medical, and insurance information.
- Schedule, reschedule, and verify patient appointments.
- Coordinated physician schedules and maintained patient flow by effectively communicating patient arrivals or delays.
- Verified and reviewed insurance eligibility and claims while collaborating with insurance carriers to ensure processing accuracy.
- Managed patient records and files using Epic EMR software; reinforced and upheld patient confidentiality per HIPAA regulations.
- Collected patient copayments and recorded payment transactions, obtaining third-party payer authorization for services and communicating outstanding balances.
Education
Associate of Science Degree - Health Information Technology
Florida Community College of Jacksonville
Jacksonville, FL01-2018
Bachelor's Degree - Health Administration
University of North Florida
Jacksonville, FL01-2013
Skills
- Healthcare Effectiveness Data and Information Set (HEDIS) reporting
- CPT/ ICD-10 coding
- HCPCS coding
- Specialization in Epic and PrimeSuite -E-clinical application knowledge
- Medical Terminology Knowledge
- Specialization in Epic and PrimeSuite -
E-clinical application knowledge - Data accuracy
- Microsoft Office Suite
- Excellent organizational skills
- Time management
- Task management
- Attention to detail
- Problem-solving abilities
Certification
- CPC, AAPC, 01/01/20
- RHIT, Registered Health Information Technician, 01/01/19
- Medical Information Coder/Biller Technical Certificate, 01/01/18
Work Preference
Job Search Status
Open to workWork Type
Full TimeSalary Range
$47000/yr - $151000/yrTimeline
HEDIS Specialist / MRA Coder
Island Doctors
04.2023 - 03.2026
Office Specialist I
Baptist Endocrinology
10.2020 - 02.2023
Associate of Science Degree - Health Information Technology
Florida Community College of Jacksonville
Bachelor's Degree - Health Administration
University of North Florida