Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Marquisa Johnson

South Carolina

Summary

Astute data analyst who brings a strong background in healthcare medical records and information management. Focused on security and performance in face of changing industry demands and regulations. Analytical in approaching database and recordkeeping problems to identify optimal improvements.

Overview

9
years of professional experience

Work History

Logistics Health – Optum Serve Federal Health Service

Credentialing Specialist
10.2020 - Current

Job overview

  • Credential for contracts such as World Trade Center, Warner Bros., VACCN, VBA, RHRP, Mepcom, COVID, etc
  • Complete Council for Affordable Quality Healthcare, Inc (CAQH) credentialing process on new providers
  • Checked applications for missing information and organized all paperwork.
  • Set up NPI numbers for providers and facilities and updated current profile information.
  • Processed documents and status-change requests, conducting followup assessment regarding enrollment inquiries.
  • Performed primary source verifications such as criminal histories, licenses and board certifications.
  • Performed database queries, compiling information according to requests and logging logistics changes.

Select Source, Blue Cross Blue Shield

Outreach Specialist/HEDIS Analyst
10.2022 - 06.2023

Job overview

  • Perform the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review
  • Extract electronic medical record data using multiple systems, and Purges files to eliminate duplication of data
  • Import and export medical records using a Secure File Transfer Protocol (SFTP) using CDX software
  • Make outbound calls to doctor offices and insurance companies to retrieve medical records
  • Complying with HIPAA (Health Insurance Portability and Accountability Act) ensuring the right to privacy for patient s records
  • Maintained electronic medical records for all clients
  • Safeguarded patient records, managing data transfers in compliance with HIPAA standards and organizational regulations.

Lancesoft, CVS

HEDIS Specialist
11.2022 - 04.2023

Job overview

  • Review patient chart for documentation of completed screenings and submit results through insurance company portals
  • Analyzes and interprets data and makes recommendations for change based on judgment and experience
  • Use Structured Query Language (SQL) to access and manipulate databases
  • Modify HEDIS data by designing/implementing machine learning, data mining, advanced analytical algorithms, programming, data science, advanced statistical analysis, artificial intelligence, computational science, software engineering, or data engineering
  • Safeguarded patient records, managing data transfers in compliance with HIPAA standards and organizational regulations.
  • Scanned and validated medical records for upload.

Healthcare Support Staffing

HEDIS Specialist
10.2022 - 04.2023

Job overview

  • Perform the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review
  • Facilitated productive clinical and technical customer relationships through intentional external communications.
  • Follow established procedures for conducting Quality Assurance Overread reviews of abstracted medical records
  • Identifies gaps in HEDIS, Quality Rating Systems (QRS), Star Ratings and state-specific quality measures
  • Analyzes and interprets HEDIS data and makes recommendations for change based on judgment and experience
  • Knowledge of QSHR and QSI, Claims software, provider network software

Medasource

HEDIS Epic Data Specialist
08.2021 - 12.2022

Job overview

  • Perform analysis of workflows, data collection, report details, and other technical issues in support of technical and business decision making efforts associated with Epic software
  • Gathered and documented statistical information to generate reports.
  • Corrected data errors and entered missing information into new data parcels being processed for clients, maintaining compliance with guidelines.
  • Epic software development life cycle for the design, development, implementation, testing, updating, integration, and maintenance of system configuration, system setup and applications tables for HEDIS data
  • Participates in change processes and prioritization; implements approved new development, system enhancements, releases and optimizations
  • Investigates, designs, develops, tests, and implements Epic systems with large data
  • Implementation experience with an Electronic Health Record system and Electronic medical record system (importing and exporting medical records)

Pyramid Staffing

HEDIS Data Specialist
11.2021 - 04.2022

Job overview

  • Follow established procedures for conducting Quality Assurance Overread reviews of abstracted medical records
  • Review claims and match provider specialty to clinical information
  • Strong data analysis and data quality skills, such as SQL, reporting and data visualization, validation, and cleansing
  • Extract electronic medical record data using multiple systems, and Purge files to eliminate duplication of data.
  • Generated reports and obtained data to develop analytics on key performance and operational metrics.
  • Utilized data analysis to monitor process efficiencies and identify data integrity exceptions.
  • Recommended metrics and models based on observed trends.
  • Analyzed and tracked data to prepare forecasts and identify trends.
  • Pulled patient records and transferred information to appropriate parties.
  • Set up patient charts and documented information in various company software.

BC Forward

HEDIS Data Abstractor
12.2020 - 05.2021

Job overview

  • Conduct specific medical reviews as necessary, analyses findings, makes recommendations for corrective actions, and prepares formal documentation for compliance with applicable standards/regulations
  • Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations
  • Experience and ability to utilize certified HEDIS software (Inovalon, Reveleer, QSHR, QSI)

BC Forward

HEDIS Data Abstractor
11.2019 - 05.2020

Job overview

  • Conduct specific medical reviews as necessary, analyses findings, makes recommendations for corrective actions, and prepares formal documentation for compliance with applicable standards/regulations
  • Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations
  • Experience and ability to utilize certified HEDIS software (Inovalon, Reveleer, QSHR, QSI)

AmeriHealth Caritas Select Health of South Carolina
Charleston, SC

HEDIS Data Analyst
03.2014 - 07.2019

Job overview

  • Scan medical records into the Select Health database; Performs medical records abstraction in support of NCQA: The Healthcare Effectiveness Data and Information Set (HEDIS)
  • Retrieve records from the EMR site, right fax, or email, and verify, Knowledge of QSHR, Jive, and Faucets/Streamline
  • HEDIS knowledge and advanced programming concepts and implementing them using the preferred programming language, Identify patterns and trends in the data
  • Hands-on and continuous monitoring of Quality Measures including HEDIS and Medicare STARs, provide reports, charts and graphs depicting HEDIS scores
  • Knowledge in SQL, relational databases, Statistical programming languages, like R or Python, machine learning, data visualization, datamining
  • Knowledge in data management to Identify patterns and trends in the data by Identify patterns and trends in the data
  • Monitor changes to HEDIS numerators, denominators and exclusions through review
  • Streamline all HEDIS activity to one vendor for successful NCQA submissions

Education

Eastern University

Master's Degree from Data Science
06.2023

University Overview

The University of the Cumberlands

Bachelor of Science from Human Service
08.2020

University Overview

Limestone College

Associate Degree from Liberal Arts
05.2011

University Overview

Skills

  • MS Office Productivity Tools (Word, Excel, Outlook, PowerPoint) Intranet, Internet, SQL & Data Objects, various report writing tools)
  • Data Visualization and Presentations
  • Analytical Problem Solving
  • Reporting Tools - NCQA
  • Statistics and SAS
  • Query Tools
  • Data Quality
  • Data Analysis
  • Data Mining
  • Data Compiling
  • BI Tool and System Design
  • Process Improvement
  • Customer Communication
  • Stakeholder Communication
  • Decision Making
  • Health Record Index Maintenance
  • Epic Systems
  • Data Entry
  • Word Processing Software
  • Office Health Records Preparation
  • Programming Languages: R & Python
  • Data Structures and Algorithms
  • Software Quality Assurance
  • Quality Improvement
  • Program Performance Analysis

Timeline

HEDIS Specialist
Lancesoft, CVS
11.2022 - 04.2023
Outreach Specialist/HEDIS Analyst
Select Source, Blue Cross Blue Shield
10.2022 - 06.2023
HEDIS Specialist
Healthcare Support Staffing
10.2022 - 04.2023
HEDIS Data Specialist
Pyramid Staffing
11.2021 - 04.2022
HEDIS Epic Data Specialist
Medasource
08.2021 - 12.2022
HEDIS Data Abstractor
BC Forward
12.2020 - 05.2021
Credentialing Specialist
Logistics Health – Optum Serve Federal Health Service
10.2020 - Current
HEDIS Data Abstractor
BC Forward
11.2019 - 05.2020
HEDIS Data Analyst
AmeriHealth Caritas Select Health of South Carolina
03.2014 - 07.2019
Eastern University
Master's Degree from Data Science
The University of the Cumberlands
Bachelor of Science from Human Service
Limestone College
Associate Degree from Liberal Arts
Marquisa Johnson