Kari Harvick
Goose Creek,SC
Summary
Detail-oriented professional with extensive experience in clinical quality analysis and provider education. Skilled in data analysis and problem resolution, contributing to improved HEDIS outcomes and fostering strong provider relationships.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Senior Clinical Quality Analyst
UnitedHealth Group/UHC
, South Carolina
01.2021 - Current
- Overreading and abstracting the following HEDIS measures: WCC, CIS, IMA, LSC and DVSCH
- Coordinating interviewing processes, training sessions, and contractor oversight
- Producing HEDIS educational resources, training guides, evaluation courses, and assessments for contractors.
- Analyzing and validating charts for MRRV audits.
- Executing quality reviews and overseeing contractors' abstraction and overreading for HEDIS measures.
Practice Performance Consultant/Manager
UnitedHealth Group/Optum
, SC
05.2017 - 01.2021
- Fostered trust-based relationships with providers to drive HEDIS collections and gap closure, boosting overall Star Ratings.
- Reviewing reports and determining trends to elevate provider performance
- Leading monthly meetings and presentations for provider groups to enhance education and assistance in Quality Programs.
- Collaborate with providers and members to identify and resolve barriers to achieve desired goals
- Extracted HEDIS data from various EMRs and presented customized reports to providers for targeting open gap opportunities
- Analyzed operational processes to streamline workflows and increase efficiency.
Credentialing Specialist
McKesson
North Charleston, SC
12.2015 - 05.2017
- Oversee maintenance of credentialing files, CAQH information, and other designated sites as required.
- Register providers with diverse health plans, including Medicare and Medicaid.
- Reviewed and analyzed primary source verification information for accuracy.
- Collaborated with internal teams to streamline credentialing procedures and enhance efficiency.
- Managed credentialing databases and ensured timely updates to records.
Provider Network Liaison
Sutter Gould Medical Foundation
Modesto, CA
07.2003 - 01.2015
- Fostering and preserving effective relationships with providers and their staff
- Addressing provider disputes, conducting claims payment analysis and supporting authorization appeals within Managed Care environment
- Coordinated efforts among providers, payors, and internal departments to ensure claims processing conformed to contract pricing and guidelines.
- Contracting responsibilities encompassing negotiation of long-term and short-term agreements
- Managed all aspects of provider education and led new provider onboarding processes.
- Educate physicians and staff on software utilized for verifying eligibility, processing claim payments, and managing provider appeals.
- Conduct monthly office staff meetings focusing on educating providers about new policies and procedures
- Direct special projects to uncover potential improvement areas
- Initiating Credentialing process for new providers
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Collaborated with senior management to identify areas of improvement within existing systems or strategies.
Owner/Biller
ALLIANCE MEDICAL BILLING
Modesto, USA
01.2003 - 12.2004
- Submitting medical claims for payment to multiple health plans and government entitiesnment payors
- Follow up and tracking of payments to ensure proper reimbursement was received
- Maintained client records and updated billing information.
- Developed knowledge of coding and billing regulations.
- Managed daily operations of medical billing processes.
- Initiated claims appeals when needed
Credentialing Coordinator
Sutter - Memorial Medical Center
Modesto, CA
01.2003 - 07.2003
- Executed all credentialing responsibilities, including primary source verification.
- Supported onboarding processes by collecting necessary documentation for new providers.
- Reviewed applications for completeness, identifying discrepancies and potential issues.
- Prepared materials for Credentialing Committee meetings and followed up on action items.
- Documented minutes for various Medical Staff Meetings to ensure accurate records.
- Coordinated CME meetings to facilitate provider education and training.
Administrative Assistant
HealthBridge PrimeCare
Turlock, CA
10.1998 - 12.2002
- Resolved provider issues and disputes regarding claims payments and procedures.
- Created and maintained pricing fee schedules to ensure accurate claims payment.
- Educated providers through orientation programs for new healthcare partners.
- Developed and updated Provider Newsletter and Provider Manual to enhance communication.
- Handled provider and claims appeals submitted by contracted health plans.
- Collaborated with contracted health plans to update policies and procedures for compliance.
- Managed all credentialing responsibilities, including primary source verification for delegated credentialing.
- Conducted chart audits in coordination with health plans as needed.
Credentialing Coordinator
Tenet - Cap Management System
Garden Grove, CA
10.1997 - 10.1998
- Managed provider applications, including verification of education and training.
- Collaborated with medical directors to streamline credentialing workflows.
- Maintained accurate databases for tracking provider credentials and renewals.
- Assisted in training new staff on credentialing procedures and systems.
- Ensured compliance with regulatory standards and organizational policies.
- Facilitated Credentialing Committee preparation and follow-up actions.
- Documented minutes for multiple medical staff meetings, ensuring accurate record-keeping.
Claims Examiner/Provider Reimbursement Coordinator
Tenet - National Health Plans
Modesto, USA
06.1993 - 10.1997
- Processed commercial and Medicare risk claims for timely payment.
- Negotiated long-term and short-term agreements with providers.
- Resolved claims disputes to enhance provider relations.
- Educated providers on claims reimbursement procedures.
Education
A.S - Business Administration
Modesto Junior College
Modesto, CA01.2012
Skills
- Networking skills
- Problem resolution
- Client engagement
- Motivational leadership
Certification
- AAPC, Certified Professional Coder
- AAPC, Certified Risk Adjustment Coder
Timeline
Senior Clinical Quality Analyst
UnitedHealth Group/UHC
01.2021 - Current
Practice Performance Consultant/Manager
UnitedHealth Group/Optum
05.2017 - 01.2021
Credentialing Specialist
McKesson
12.2015 - 05.2017
Provider Network Liaison
Sutter Gould Medical Foundation
07.2003 - 01.2015
Owner/Biller
ALLIANCE MEDICAL BILLING
01.2003 - 12.2004
Credentialing Coordinator
Sutter - Memorial Medical Center
01.2003 - 07.2003
Administrative Assistant
HealthBridge PrimeCare
10.1998 - 12.2002
Credentialing Coordinator
Tenet - Cap Management System
10.1997 - 10.1998
Claims Examiner/Provider Reimbursement Coordinator
Tenet - National Health Plans
06.1993 - 10.1997
A.S - Business Administration
Modesto Junior College
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