Jessica Gundy
Tampa
Summary
Results-driven HEDIS Clinical Quality Consultant II with extensive experience in healthcare quality improvement initiatives. Expertise in HEDIS abstraction, hybrid chart review, and data validation, with strong knowledge of NCQA HEDIS technical specifications. Proven ability to identify documentation gaps, provide provider education, and ensure audit readiness while maintaining data integrity. Strong analytical and problem-solving skills with a consistent track record of enhancing measure performance and compliance.
Overview
15
15
years of professional experience
Work History
Clinical Quality Consultant II
UnitedHealth Group
Remote
02.2023 - Current
- Ensured compliance and audit readiness through thorough medical record reviews.
- Identified documentation gaps affecting quality measures, enhancing data validation processes.
- Collaborated with teams to meet HEDIS reporting and submission deadlines effectively.
- Analyzed measure outcomes, driving quality improvements and recommending corrective actions.
- Maintained HIPAA standards and data integrity during chart abstraction and reporting.
- Streamlined clinical data retrieval using EMR/EHR systems and abstraction tools.
Quality Outreach Specialist
Diagnostic Medical Clinic
Remote
11.2022 - 02.2023
- Enhanced patient care quality by auditing EHR charts for compliance.
- Tracked productivity by updating internal files with completed work metrics.
- Led clinical quality initiatives to improve overall patient care standards.
- Collaborated with clinical staff to meet quality measures and metrics.
- Disseminated HEDIS and quality information to relevant stakeholders effectively.
- Developed and implemented action plans to boost quality ratings.
Chronic Care Manager
Cosan
Remote
04.2022 - 11.2022
- Improved patient outcomes by implementing individualized care plans using Cosan Group software.
- Facilitated care coordination through regular patient contact and compliance management.
- Streamlined continuity of care via interdisciplinary collaboration and discharge planning.
- Promoted self-care management through targeted health education and promotion initiatives.
- Monitored care delivery and collaborated with physicians to implement evidence-based guidelines.
- Coordinated scheduling and test completion among care teams in patient-centered medical homes.
HEDIS Medical Care Coordinator
Florida Medical Clinic
Remote
02.2018 - 03.2022
- Patient follow-up by contacting recently discharged individuals promptly.
- Created transition of care documents by reviewing hospital discharge records.
- Coordinated access to health services, implementing comprehensive care and treatment plans.
- Facilitated continuity of care through effective transfer coordination and discharge planning.
- Empowered patients with self-care management via health education and promotion initiatives.
- Collaborated with physicians to monitor care delivery and ensure evidence-based practices.
Team Lead Registered Medical Assistant
Unitedhealth Group-Wellmed
Tampa
05.2015 - 12.2017
- Patient screening processes for Geriatric patients with insurance coverage.
- Conducted free preventative health screenings including phlebotomy and spirometry tests.
- Reviewed medical records for accuracy and compliance, ensuring confidentiality maintained.
- Collected and labeled specimens, coordinating with labs for timely test results.
- Delivered exemplary customer service, assisting callers with health service inquiries.
- Trained new Medical Assistants, preparing them for their roles effectively.
Customer Service Representative
Alorica
Tampa
06.2013 - 05.2015
- Offered American Express accepting small business owner’s free advertising.
- Maintained an open line of communication between customers, client services and management staff.
- Prepared daily logs in Microsoft Word.
Inside Sales Representative
Ultimate medical academy
Tampa
01.2011 - 08.2011
- Provided career services to students, graduates and alumni by building relationships with employers.
- Built effective relationships with local and regional corporations, non-profit and government organizations and community partners to identify employment opportunities and to promote the school's qualified students, graduates and alumni.
- Completes telephone interviews and e-mail correspondence to prospective employers to determine their employment needs.
- Assisted students and graduates in securing employment in their field of training.
- Provided career coaching, including seminars and workshops on interviewing techniques and other job search skills training to students and alumni.
- Ensured the up-to-date maintenance of the Career Services database, documentation, reports and students records in accordance with company policies, government regulations and accreditation standards.
- Consistently met department metrics and quotas including number of dials, talk time, interviews, hires and monthly quota of placed graduates.
Education
Bachelor of Science - Healthcare Administration
Grand canyon university
Phoenix, AZ01.2023
Registered Medical Assistant -
Everest University
Tampa, FL06.2014
High School Diploma -
Wright city high school
Wright City, MO01.2008
Skills
- EMR/EHR Navigation
- Leadership experience
- HEDIS Abstraction Tools
- Medicare and Medicaid Quality Programs
- STAR Ratings
- Gap Analysis
- Performance Monitoring
- Quality Reporting Dashboards
- Secure File Handling
- HIPAA Compliance
- Advanced knowledge of medical terminology
- Coding
- Procedures
- Attention to Detail
- Data Integrity
- Microsoft office
- CPT/ICD-10 coding knowledge
- Health insurance databases
- Provider Outreach and Education
- Process Improvement
- Independent and Remote Work
Timeline
Clinical Quality Consultant II
UnitedHealth Group
02.2023 - Current
Quality Outreach Specialist
Diagnostic Medical Clinic
11.2022 - 02.2023
Chronic Care Manager
Cosan
04.2022 - 11.2022
HEDIS Medical Care Coordinator
Florida Medical Clinic
02.2018 - 03.2022
Team Lead Registered Medical Assistant
Unitedhealth Group-Wellmed
05.2015 - 12.2017
Customer Service Representative
Alorica
06.2013 - 05.2015
Inside Sales Representative
Ultimate medical academy
01.2011 - 08.2011
Bachelor of Science - Healthcare Administration
Grand canyon university
Registered Medical Assistant -
Everest University
High School Diploma -
Wright city high school