KELLY DICUS

• Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
• Influenced care outcomes by implementing improvements and optimizing health information technology.
• Applied medical subject matter knowledge to improve IT systems and functions.
• Researched and validated clinical data.
• Over read & abstracted medical records
• Quality score maintained above 95%
• Skilled at working independently and collaboratively in team environment.
• Self-motivated, with strong sense of personal responsibility
• Proven ability to learn quickly and adapt to new situations.
• Worked well in team setting, providing support and guidance

• •Responsible for collection of information from members’ records pertaining to specific Gaps in Care, entering information in to company portal by using company software & database.
  •Experienced in Commercial and Medicare Measures: ABA, CBP, CDC, COL, IMA, PPC, WCC, TRC, COA, MRP, etc.
  •Performed special projects for Team Lead/Management as necessary.
  

• Over read and abstracted member medical records in timely manner from home in accordance with NCQA criteria. Entered into company database
  •Maintained above 95% Quality Score
  •Experienced in Commercial and Medicare Measures: ABA, CBP, CDC, COL, IMA, PPC, WCC, COA, TRC, MRP, etc.
• Met production metrics with minimal effort
• Analyzed and interpreted patient, nursing or information systems data to improve care.

• Utilized advanced knowledge of clinical processes and related technology to optimize company health information processes and procedures.
• Reviewed medical records for information to meet criteria for measure specific gaps of care for Medicare Stars Program
• Entered Data into company Database
• Maintained Quality Score of 95 % and above

• Over read and abstracted member medical records in timely manner from home in accordance with NCQA criteria. Entered into company database.
• Maintained above 95% Quality Score
• Experienced in Commercial and Medicare Measures: ABA, CBP, CDC, COL, IMA, PPC, WCC, COA, TRC, MRP, etc.

•Responsible for collection of information from members’ records pertaining to specific Gaps in Care,entering information in to company portal by using company software & database.
•Experienced in Commercial and Medicare Measures: ABA, CBP, CDC, COL, IMA, PPC, WCC, COA, MRP,etc.
•Performed special projects for Team Lead/Management as necessary.
Aerotek -

• Medicare Advantage QI & Stars Program
• Responsible for performing reviews of Provider Assessment Forms, medical records and other supplemental data sources which ensure that the quality and performance of network providers complies with standards adopted by BlueCross BlueShield of Tennessee (BCBST) and in accordance with CMS
• The coordinator lead each respective region during the annual Supplemental Data Collection project with medical record retrieval, abstraction and over read of contract nurses
• Oversight of contract staff for the Supplemental Data Collection project and lead regional retrieval and abstraction of records with collaboration of provider offices
• Responsible for contacting Office Manager at provider office to set up onsite visits or to set up remote access to EMR
• Effectively analyze outcome of reviews and communicate results to department manager, utilizing established audit tools reflective of national accreditation standards and regulatory agency requirements
• Communicated effectively with internal and external customers to enhance regional data collection operations
• Analyze and contribute to internal reports to communicate data collection outcomes and deficiencies to internal oversight committees
• Productivity standards and inter-rater reliability guidelines met
• Met routinely with HEDIS Lead and Program Managers to discuss abstraction trends
• Maintained Confidentiality and HIPPA regulations.

• Responsible for collection of information from members’ records pertaining to specific Gaps in Care, entering information in to company database by using company software & database
• Experienced in Commercial and Medicare Measures: ABA, CBP, CDC, COL, IMA, PPC, WCC, COA, MRP, etc.