Jessica Martin
Clanton,AL
Summary
Proven healthcare professional with a track record of enhancing HEDIS compliance rates and healthcare quality management at CHILTON MEDICAL ASSOCIATES. Skilled in medical record review and critical thinking, demonstrated through successful project management and quality improvement initiatives. Excelled in audit preparation and regulatory standards, achieving a minimum of 4-STAR HEDIS rating through strategic provider training and performance analysis.
Overview
5
5
years of professional experience
Work History
HEDIS Registered Nurse Quality Analyst
CHILTON MEDICAL ASSOCIATES
04.2023 - Current
- Managed prioritization of various competing tasks within tight timeframes while maintaining the highest standard of work quality throughout all phases of project completion stages.
- Participated in annual HEDIS auditing projects, consistently meeting deadlines while maintaining exceptional attention to detail and accuracy levels.
- Maintained up-to-date knowledge of evolving industry standards and regulations, ensuring continued excellence in the delivery of high-quality patient care.
- Delivered ongoing training sessions for medical staff on HEDIS measures and documentation requirements, enhancing overall team competency and performance.
- Trained providers and staff on HEDIS and GPRO measures and remained accountable for providers achieving minimum of 4-STAR for HEDIS .
- Assisted with the development of targeted interventions aimed at improving specific areas identified as needing improvement during HEDIS performance assessments.
- Collected, summarized and trended provider performance data to identify and strategize opportunities for provider improvement.
- Improved HEDIS compliance rates by conducting thorough medical record reviews and data analysis.
Medical Coding and Billing Specialist
DIRECT BILLING SERVICES
08.2021 - 04.2023
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Provided exceptional customer service to patients, addressing their concerns regarding insurance claims or billing issues with empathy and professionalism.
- Maintained patient confidentiality by adhering to strict HIPAA regulations during all aspects of the coding and billing processes.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
Certified Medical Assistant
AMERICAN FAMILY CARE
03.2019 - 05.2021
- Assisted physicians with various procedures, ensuring comfort and accuracy for optimal patient outcomes.
- Enhanced clinic efficiency by thoroughly documenting patient information and updating electronic health records.
- Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
- Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Verified eligibility and compliance with authorization requirements for service providers.
- Processed new medication and refill requests for authorization.
Education
Associate of Applied Science - NURSING
Jefferson State Community College
Birmingham, AL05.2023
Skills
- HIPAA Regulations Knowledge
- Medical record review
- Electronic Health Records Proficiency
- Critical thinking abilities
- Healthcare compliance
- Project management experience
- Clinical Documentation Expertise
- Healthcare Quality Management
- Regulatory Standards Understanding
- HEDIS Measure Knowledge
- Audit preparation
- Quality Improvement
Timeline
HEDIS Registered Nurse Quality Analyst
CHILTON MEDICAL ASSOCIATES
04.2023 - Current
Medical Coding and Billing Specialist
DIRECT BILLING SERVICES
08.2021 - 04.2023
Certified Medical Assistant
AMERICAN FAMILY CARE
03.2019 - 05.2021
Associate of Applied Science - NURSING
Jefferson State Community College