Summary
Overview
Work History
Education
Skills
References
Timeline
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FLEMY THOMAS

Nesconset,NY

Summary

Clinical Quality Auditor with over 5 years of successful experience in HEDIS abstraction and Auditing. Recognized consistently for performance excellence and contributions to success in Health Insurance industry. Experience in policy development and staff management procedures positively impacting overall morale and productivity. Enthusiastic HEDIS RN eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of QI process. Motivated to learn, grow and excel in this Health care Industry.

Compassionate nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing direct patient care and support. Quality-focused and efficiency-driven leader.

Overview

16
16
years of professional experience

Work History

Registered Nurse

Carillon Nursing and Rehabilitation Center
Huntington, NY
01.2024 - Current
  • Recorded patient condition, vital signs, recovery progress and medication side effects.
  • Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
  • Actively participated in quality improvement initiatives within the department.
  • Advocated for patients by supporting and respecting basic rights, values, and beliefs.
  • Instructed patients on proper self-care techniques at home following discharge from the hospital.
  • Conducted intake assessments with patients and relatives to gather case history.
  • Assessed, planned, implemented and evaluated nursing care for assigned patients.
  • Demonstrated knowledge of current trends in nursing practices by attending continuing education classes or seminars.
  • Ensured compliance with standards of professional practice as well as state and federal regulations related to health care delivery services.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
  • Administered local, inhalation or intravenous anesthetics to patients undergoing procedures.
  • Maintained personal and team compliance with medication administration standards and patient care best practices.
  • Provided patient and family health education focusing on self-management, prevention and wellness.
  • Evaluated effectiveness of interventions through ongoing assessment of patient responses.
  • Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
  • Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
  • Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
  • Performed triage assessments of walk-in patients in a clinic setting.
  • Counseled patients regarding medication side effects or lifestyle changes necessary for improved health outcomes.
  • Maintained thorough, accurate and confidential documentation in electronic medical records.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Coordinated discharge planning activities including arranging follow up appointments or referrals for additional services.
  • Provided emotional support and comfort to families during difficult times.
  • Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
  • Monitored patients after surgery, answered questions and provided home care strategies.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Modified existing software systems to enhance performance and add new features.
  • Displayed strong telephone etiquette, effectively handling difficult calls.
  • Prioritized and organized tasks to efficiently accomplish service goals.

Clinical Quality Auditor (RN)

Emblem Health
New York, NY
01.2016 - 01.2024
  • Performs Chart Review/auditing while maintaining the confidentiality of protected health information (Proficient in first read, over read and pending in all Admin, Hybrid/QAAR measures)
  • Collaborate with clinicians, administrators, and QC teams on QI activities such as chart reviews and accurate and complete documentation and coding
  • Communicated significant findings, including reviews not meeting criteria and other potential risk management issues to the Quality Management department managers
  • Provide clinical and administrative support to the Clinical Supervisor, HEDIS Manager, VP of Performance Improvement as needed, to include drafting/editing letters, mailings, faxes, coordinate schedules, phone calls that relate to HEDIS projects
  • Managed quality assurance program, including on-site evaluations, internal audits and customer surveys
  • Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately
  • Drove operational improvements which resulted in savings and improved profit margins.
  • Ensured timely completion of all assigned tasks within set deadlines.
  • Conducted audits on internal controls and developed reports on findings.
  • Supervised audit staff to align goals with company and deliver excellent internal audit services.
  • Assisted in preparing audit plans based on established objectives and standards.
  • Drafted reports summarizing audit results while highlighting any irregularities or inconsistencies found during the process.
  • Managed and trained team members to enhance audit department performance and increase operational efficiency.
  • Completed day-to-day duties accurately and efficiently.
  • Worked with cross-functional teams to achieve goals.
  • Assisted with customer requests and answered questions to improve satisfaction.
  • Conducted intake assessments with patients and relatives to gather case history.

Staff Nurse (RN)

NYC Children's Center - Queens Campus
Glen Oaks, NY
05.2017 - 11.2017
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information
  • Implemented care plans for patient treatment after assessing physician medical regimens
  • Performed ongoing assessments to evaluate mental health needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care
  • Accurately documented all elements of nursing assessment, including treatment, medications and IVs administered, discharge instructions and follow-up care
  • Observed and reported patient condition, progress and medication side effects to accurately document updates
  • Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Evaluated the effectiveness of nursing interventions and modified plans as needed.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care.
  • Utilized an electronic medical record system to store patient information securely.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Collaborated with cross-functional team to define features and build powerful and easy-to-use products and customer-facing workflow tools.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
  • Administered prescribed medications and treatments in accordance with approved nursing protocols.
  • Monitored vital signs, such as blood pressure, temperature, respiration rate, pulse rate and weight.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Provided emotional support to families facing difficult decisions about a loved one's care.
  • Oversaw patient admission and discharge processes to coordinate related paperwork.
  • Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.

Chart Abstractor/Auditor (LPN/RN)

Maxi Return
Staten Island, NY
05.2015 - 01.2016
  • Abstract complete and accurate data from the patient's medical records while maintaining productivity and quality standards
  • Monitors and problem solves as necessary on issues such as invalid patient information in order to assure a complete and accurate abstract of the patient's paper chart
  • Demonstrates a service-oriented approach to his/her position by conveying courtesy, respect, enthusiasm and a positive attitude in work situations, by showing initiative and offering assistance to other staff members and office personnel in the completion of the department's work, and by making patient care and/or departmental service the first priority
  • Abstracts patient medical records from different EMR systems into Epic EMR system
  • Performs periodic audits to assess the quality of charts being abstracted
  • Orients new hires to efficiently navigate and abstract documentation for a cohesive conversion.
  • Maintained a thorough knowledge of medical terminology and anatomy and physiology related to coding and abstracting.
  • Utilized various computer software programs for data entry purposes such as MS Word, Excel, Access.
  • Participated in interdisciplinary meetings focusing on improving overall efficiency of chart abstraction processes.
  • Pulled patient records and transferred information to appropriate parties.
  • Interpreted physician's orders, notes and other forms of communication accurately into standardized codes for reimbursement purposes.
  • Determined and implemented techniques to improve medical records retrieval process.
  • Followed up with clinicians or other staff members when additional information was needed to complete abstraction process.
  • Performed quality assurance reviews on abstracted charts for accuracy.
  • Collaborated with physicians, nurses and other healthcare professionals regarding documentation requirements for accurate code assignment.
  • Drafted reports summarizing audit results while highlighting any irregularities or inconsistencies found during the process.
  • Attended continuing education courses in order to stay current with changes in industry standards and regulations.
  • Developed strategies aimed at increasing productivity while maintaining high quality standards for coded data.
  • Analyzed all necessary documentation to determine appropriate code assignment according to accepted coding guidelines.
  • Identified discrepancies between the source documents and the coded data entries.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.

LPN Charge Nurse

Komanoff Center for Geriatrics & Rehab
Long Beach, NY
09.2011 - 02.2015
  • Provided professional care to patients in the Skilled Nursing Home setting - Delivered skilled nursing care in routine/stressful periods at the highest standards of excellence
  • Participated in inter-disciplinary nursing team meetings to improve policies/procedures and to ensure adherence to safety procedures
  • Experienced in working with gero-psychiatric patients
  • Assist RN to plan and coordinate nursing care and maintain reports of care and assessments
  • Order and administer medications as well as supervise, assist and train CNA's in relation to patient's health care
  • Monitored patients' conditions and reported changes in physical ability, appearance and behavior to discuss treatment with physicians
  • Precepted student nurses and oriented new hires, providing guidance and mentorship when teaching on hospital policies, emergency procedures and nursing best practices
  • Implemented interventions, including medication and IV administration, catheter insertion and airway management
  • Managed elements of patient care, from admission to discharge or transfer to other units, using nursing expertise to conduct assessments, administer medications, initiate nursing and emergency interventions, contribute to care plan development and educate patients.
  • Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives.
  • Carried out physician orders accurately while adhering to hospital policies and procedures.
  • Communicated effectively with patients and loved ones to explain diagnoses, treatment options and procedures.
  • Monitored medication administration for accuracy, compliance, and effectiveness of treatment plan.
  • Collaborated with multi-disciplinary staff to improve overall patient care and response times.
  • Took temperatures or blood pressures, dressed wounds and provided other basic patient care or treatments.
  • Developed strategies for improving quality of care standards within the unit or department.
  • Promoted positive relationships between patients, families, visitors, physicians, nurses, volunteers.
  • Supervised the activities of other nursing staff members and provided guidance when necessary.
  • Delivered emotional, psychological and spiritual support to patients and families to promote compassionate environment.
  • Guaranteed exceptional care quality by correctly administering medication, inserting and caring for catheters, dressing and changing wounds and assisting with personal hygiene.
  • Educated clients, patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
  • Displayed strong telephone etiquette, effectively handling difficult calls.
  • Approached customers and engaged in conversation through use of effective interpersonal and people skills.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.

Medical Assistant

Hillside Internal Medicine and Geriatrics
01.2008 - 08.2011
  • Conducted preliminary evaluations, including measuring weight, temperature and blood pressure, and documented results with accuracy
  • File & scan documents related to medications, vital signs and medical histories into electronic medical record and renew prescriptions for patients as per physician's order
  • Schedule and get prior authorizations for MRIs, Cat Scans and other tests with hospitals for patient testing
  • Schedule surgeries by making arrangements with the surgical center, verifying times with patients and preparing charts, pre-admission and consent forms
  • Maintain safe, secure and healthy work environment by establishing and following standards and procedures and complying with legal regulations
  • Serve and protect the physician or healthcare provider practice by adhering to professional standards, policies and procedures, federal, state and local requirements and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards
  • Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions
  • Oriented and trained new staff on proper procedures and policies
  • Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment
  • Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.

Education

Bachelor's - Science - Nursing

Chamberlain College of Nursing
05.2015

Associates Degree - Nursing

Nassau Community College

Skills

  • EMR - Epic, MedcomSoft, Centricity, Intergy, McKesson, AllScrpits, DigiDMS
  • Hedis Softwares - Med Capture, QSHR, Reveleer
  • Medical Record Abstraction
  • Clinical Quality Improvement
  • Clinical team oversight
  • High-quality customer service
  • Fast-learner
  • Root Cause Analysis
  • Audit Coordination
  • Process Evaluations
  • Ethical Standards
  • Regulatory Compliance

References

References available upon request.

Timeline

Registered Nurse

Carillon Nursing and Rehabilitation Center
01.2024 - Current

Staff Nurse (RN)

NYC Children's Center - Queens Campus
05.2017 - 11.2017

Clinical Quality Auditor (RN)

Emblem Health
01.2016 - 01.2024

Chart Abstractor/Auditor (LPN/RN)

Maxi Return
05.2015 - 01.2016

LPN Charge Nurse

Komanoff Center for Geriatrics & Rehab
09.2011 - 02.2015

Medical Assistant

Hillside Internal Medicine and Geriatrics
01.2008 - 08.2011

Bachelor's - Science - Nursing

Chamberlain College of Nursing

Associates Degree - Nursing

Nassau Community College

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FLEMY THOMAS