Systematic professional well-versed in software development and testing protocols. Helps teams produce high-quality work by completing thorough quality assurance evaluations. Strong communicator and multitasker with organized, detail-oriented approach. Proficient in complex software deployments. Knowledgeable in a variety of medical evaluation and treatment methods. Proficient in administrative management, and medical analysis.
Overview
22
22
years of professional experience
Work History
Quality Analyst Outreach Coordinator
Aetna/CVS Health
Atlanta, GA
03.2023 - Current
Developed benchmarks for measuring and monitoring strategic changes and organizational goals.
Prepared reports summarizing results of outreach activities for senior management review.
Interacts with providers and/or members to improve healthcare outcomes such as increased preventive care compliance.
Independently map out provider outreach work plan and execute deliverables.
Support complex provider partners with HEDIS gaps in care, data feed, and remote medical record collection discussions and education.
Provides support for HEDIS quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.
English and Math Tutor
KAIZEN E'LITE LLC
Duluth, GA
04.2020 - Current
Assisted students in developing effective study strategies for English and Math courses.
Tutored students and delivered individualized lesson plans and study guides on subject matter Administered test, quizzes, and other assignments gauges students' learning and knowledge of course material.
Encouraged development of communication skills and higher critical thinking skills through writing assignments, classroom presentation experiential learning.
Facilitated group discussion on mathematical education and applied feedback to individualized lesson plans.
Built student self-confidence by working through stages of study concepts and using positive reinforcement techniques.
Senior Recruitment Coordinator
AMS/Delta Airlines, ACS,
Atlanta, GA
09.2021 - 04.2023
Support Delta Airline's Talent Acquisition Team with 90% of travel and 10% remote.
Facilitate with onboarding, scouting, interviewing, hiring, preparing offer letters, processing employee referrals, background checks and training new employees.
Document, support and update ATS to ensure data accuracy for reporting, audit, and compliance.
Aid with moving 100 candidates per event through the application, interviewing, and pre-employment processes.
Collaborate and provide support on management projects to improve the hiring and HR processes.
Collaborated with other departments within the organization on recruiting initiatives, such as diversity programs or employee referral bonuses.
Tracked recruiting expenses against budget allocations throughout the year.
Hedis Abstractor
Centene, Superior Health Services
Atlanta, GA
01.2021 - 05.2021
Created and maintained accurate records of departmental activities, including budgets, personnel documents and project timelines.
Gathered patient information by collecting demographic information from a variety of sources; interacting with registration areas and physicians' offices; retrieving information, data mining, and uploaded to the online portal.
Reviewing and comparing data abstracted from medical records by the third-party vendors with the proper measure guidelines.
Researching any discrepancies found by reviewing medical records, claims data, showing trends, documenting any errors found, and any other relevant information.
Managed primary patient index by completing assigned portion of daily audit trail; communicate problems according to established procedures, continuity of work operations by documenting,irregularities, and continuing needs.
CARE ENGAGEMENT SPECIALIST
Centene, Superior Health Services
Atlanta, GA
09.2020 - 12.2020
Managed outbound and inbound calls for members, scheduled doctor appointments, and analyzed data for call report.
Aided members with Health Screenings to take advantage of additional benefits available by educating members on enhanced services that are available and recommending preferred providers.
Facilitated tasks necessary to promote member compliance such as verifying appointments, obtaining lab results and monitor inpatient census.
Trained new team members on best practices in engagement and communication strategies.
HEDIS ASTRACTOR
CENTENE, WELLCARE
Atlanta, GA
01.2020 - 05.2020
Created and maintained accurate records of departmental activities, including budgets, personnel documents and project timelines.
Applying structured auditing criteria to medical records to decide compliance standards.
Demonstrating ability in the requirements and parameters of mandated performance measures.
Maintaining productivity levels as decided by the Quality Improvement Department.
Accurately entering the results of chart audits into the database. Monitoring progress towards completion of the annual HEDIS chart abstraction.
Researched and prepared reports required by management or governmental agencies.
Recruited, interviewed and selected employees to fill vacant roles.
Subrogation Analyst
HMS
Atlanta
06.2019 - 12.2019
Provided guidance and support to other staff members about the process for submitting subrogation claims.
Managed all casualty or estate functions involving several state Medicaid beneficiaries or deceased Medicaid beneficiaries
Confirm and validate third party liability, probate, beneficiary asset research, and managed a variety of cases with current and accurate notes from creation to recovery
Interact professionally (i.e., on incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients' family members and client
Negotiated settlement amounts per contract guidelines, liens, claims, conduct all case document review, and updates as needed to progress the case to recovery
ACCOUNT-RETAIL EXECUTIVE SUPERVISOR
NX Direct
Norcross, GA
07.2018 - 07.2019
Negotiated contracts with suppliers for better terms and discounts.
Organized training sessions for new employees on company policies and procedures.
Xfinity/Spectrum assisted with staff development by implementing effective, hands-on training programs for new employees, maximizing performance, recruiting, and engagement.
Assisted with HR, back-office responsibilities, regional national conferences, led workshops, morning meetings, drills, all ranging from sales fundamentals to personal finance and monitored multiple databases to keep track of all company inventory.
Sourced 20 new vendors and suppliers to boost product offerings and increase profit margins at each store location.
HEDIS Field Reviewer
Athem
Atlanta, GA
01.2019 - 05.2019
Participated in training sessions aimed at increasing understanding of HEDIS protocols.
Developed strategies for improving provider performance related to quality initiatives.
Collect 1500 medical records and reports from provider offices based on member-needed services reports, and load data into the software application Placed 100 telephone calls to provider offices; monitoring fax process request records; overseeing incoming, and outgoing fax documents.
Researched claim systems to locate where members received care, completed chart abstraction, book appointments, verify information, and communicate with provider offices.
Education
Bachelor of Science - Bachelor Of Applied Business
Argosy University
Chicago Heights, IL
05-2017
Associate of Arts - Associate of Science: Clinical Medical Assisting
National College of Business And Tech-Lexington
Lexington, KY
11-2006
Skills
Structured Query Language mastery
Six Sigma methodology
SQL understanding
Training material development
Project management expertise
Audit processes
Data Analysis
Quality Improvement
Applicant Tracking Systems
Analytical and Critical Thinking
Active Listening
Problem-Solving
Data Entry
Chart Abstracting
Online training experience
Training and Development
Medical billing and coding
Global recruitment
Recruitment strategies
Quality processes
Languages
English
Native language
Spanish
Upper Intermediate (B2)
B2
French
Upper Intermediate (B2)
B2
Arabic
Upper Intermediate (B2)
B2
Timeline
Quality Analyst Outreach Coordinator
Aetna/CVS Health
03.2023 - Current
Senior Recruitment Coordinator
AMS/Delta Airlines, ACS,
09.2021 - 04.2023
Hedis Abstractor
Centene, Superior Health Services
01.2021 - 05.2021
CARE ENGAGEMENT SPECIALIST
Centene, Superior Health Services
09.2020 - 12.2020
English and Math Tutor
KAIZEN E'LITE LLC
04.2020 - Current
HEDIS ASTRACTOR
CENTENE, WELLCARE
01.2020 - 05.2020
Subrogation Analyst
HMS
06.2019 - 12.2019
HEDIS Field Reviewer
Athem
01.2019 - 05.2019
ACCOUNT-RETAIL EXECUTIVE SUPERVISOR
NX Direct
07.2018 - 07.2019
Bachelor of Science - Bachelor Of Applied Business
Argosy University
Associate of Arts - Associate of Science: Clinical Medical Assisting