Juliana Erickson
Gibsonia,Pa
Summary
Experienced HEDIS data abstractor with a proven record of accuracy and efficiency.
Results-oriented achiever with the ability to meet time sensitive target dates and times. Highly focused on reviewing the provided medical records and locating the necessary data based on NCQA standards. Self motivated to outreach to multiple sources for additional records, as needed.
Hardworking and passionate job seeker ready to help team achieve intended goals of the organization.
Overview
22
22
years of professional experience
Work History
HEDIS Data Abstractor Temp Position
UPMC Health Plan
01.2022 - 04.2024
- Review, evaluate, and abstract data from medical records supplied by healthcare providers.
- Use critical thinking and persistence in locating and retrieving additional medical records if needed.
- Work collaboratively with other teams and providers.
- Use the healthcare data application with precision.
- Perform with high degree of accuracy and productivity.
HEDIS Coordinator
UPMC Health Plan
01.2019 - 09.2021
- Review medical records uploaded by providers into the Novillus (CGMA) application
- Determine if criteria for gap closure have been met
- Participate in yearly HEDIS audit project
- Work with providers; request and evaluate reports for member compliance
Case Manager QI Dept.
UPMC Health Plan
01.2016 - 12.2019
- Outreach to members regarding specific Health Care screening recommendations
- Assess and address any obstacles that prevent their achieving the recommendations.
- Provide support and education
Practice Based Care Manager (PBCM)
UPMC
01.2012 - 12.2015
- Provide support to UPMC members who are patients in my assigned primary care practices.
- Identify and support those members who are high risk for medical and/or behavioral health issues.
- Evaluate self-management skills of patients and their caregivers.
- Observe for obstacles and develop a plan to support and educate, when needed.
- Collaborate with members of the patient’s UPMC Care Coordination Team which includes physicians, physician extenders, pharmacists, social workers, and health coaches.
- Monitor and address those members who are high utilizers of the Emergency Department and other urgent care facilities.
- Identify, review, and engage those members who are due for routine screenings.
- Utilize applications: Health Planet, EPIC, and Ika ProHedis computer applications.
Clinical Nurse and Quality Improvement Nurse- Emergency Department
UPMC Passavant Hospital
01.2002 - 12.2012
- Responsible for the follow-up care of patients seen in the Emergency Department.
- Daily systematic review and proactive care of patients, when necessary.
- Collect and review data for the purpose of process improvement for such issues as Hospital Core Measures, patient turn-around times in the Emergency Department, audits of compliance of JACHO and State regulations, and many other internal needs of the Emergency Department.
- Communicate with physicians, physician extenders, nurses, technicians regarding education and compliance of systems set up for the purpose of quality improvement.
- Follow-up with specific issues as requested by the Medical Director that often involved review of Emergency Department systems that affect patient care.
- Computer experience includes Microsoft Word, Excel and Power Point.
- Worked in the Emergency Department as a staff nurse, when needed.
- Participated in the 2005 UPMC Katrina effort with 13 other UPMC nurses.
- We worked as relief staff for the many deployed military nurses at Lackland Air Force Base in San Antonio, Texas.
- Spent 4 weeks working in the Emergency Department on the base and supplemented many hours of volunteer time to the shelters caring for the displaced residents who required medical monitoring and attention.
Education
RN to BSN Program -
Waynesburg University
Waynesburg, Pennsylvania01.2008
Associate of Science degree - Nursing
CCAC Center North
Pittsburgh, Pennsylvania01.1990
Skills
- HIPAA compliance assurance
- HEDIS Medical Data retrieval with accuracy
- Proficient with analytical evaluation
- Strong problem-solving abilities
- Ability to recognize a need for follow-up actions
- Investigational skills for locating additional records
- Acute awareness of required time sensitivity
- Easily adapt to changes
- Proficient in EPIC EHR database
- Experienced with various EHR systems
- Adept in Cotiviti analytic technology
- Enjoy the challenges of data mining and analysis
Professional Nursing License
Pennsylvania, RN-309192
Timeline
HEDIS Data Abstractor Temp Position
UPMC Health Plan
01.2022 - 04.2024
HEDIS Coordinator
UPMC Health Plan
01.2019 - 09.2021
Case Manager QI Dept.
UPMC Health Plan
01.2016 - 12.2019
Practice Based Care Manager (PBCM)
UPMC
01.2012 - 12.2015
Clinical Nurse and Quality Improvement Nurse- Emergency Department
UPMC Passavant Hospital
01.2002 - 12.2012
RN to BSN Program -
Waynesburg University
Associate of Science degree - Nursing
CCAC Center North
Similar Profiles
Brenda PalmaBrenda Palma
Administrative Coordinator at Department of Health Economics, UPMC Health Plan (remote)Administrative Coordinator at Department of Health Economics, UPMC Health Plan (remote)
AMANDA BUSALACCHIAMANDA BUSALACCHI
Health Care Concierge at UPMC Health PlanHealth Care Concierge at UPMC Health Plan
Nancy Kent KruperNancy Kent Kruper
Director of Utilization Management at UPMC Health PlanDirector of Utilization Management at UPMC Health Plan
Taylor MCWHIRTERTaylor MCWHIRTER
Medical Assistant at Martin G. Gregorio, MD & AssociatesMedical Assistant at Martin G. Gregorio, MD & Associates
Robert MarcouxRobert Marcoux
Client Executive at VMwareClient Executive at VMware