Monique Frome
Port Richey,Florida
Summary
Dedicated healthcare professional with 26+ years of experience in medical chart auditing, HEDIS review and abstraction, medical assisting, insurance prior authorizations, and medical coding. Skilled in large-scale data analysis, ICD-10/ICD-9 verification, and navigating all major EMR systems. Proven success working in Medicare Advantage, STARS, NCQA, CMS audits, data quality operations, and multi-state project-based assignments. Adept in workflow optimization, accuracy review, quality compliance, and high-volume chart processing. Recognized as a quick learner, strong communicator, and collaborative project team member.
Overview
29
29
years of professional experience
1
1
Certification
Work History
HEDIS Project Over reader
Optum
02.2025 - 01.2026
- Conducted large-scale medical chart reviews and accuracy validation for multiple HEDIS measures.
- Entered and analyzed clinical data in the Optum Quality Gap Assist System to ensure compliance.
- Identified compliant vs. non-compliant metrics, verified timelines, and corrected data discrepancies.
- Performed root-cause analysis on data issues and executed resolutions.
- Managed high-volume chart deadlines, maintained productivity requirements, and ensured data integrity.
- Supported case management functions including account setup, data research, and audit preparation.
HEDIS Quality Specialist III / Project Coordinator
HTA
01.2024 - 03.2024
- Performed advanced HEDIS abstraction and data operations for Medicare Advantage plans.
- Worked with STARS, NCQA, CMS audits, and technical spec interpretation for CBP and other measures.
- Entered and validated data in QSHR, Cotiviti, KPN, and other audit platforms.
- Marked non-compliant BP readings, abstracted clinical data, and followed up on missing chart components.
- Verified ICD-10 coding accuracy and analyzed spreadsheets for audit-ready completeness.
- Coordinated project flow, prioritized multiple initiatives, and maintained strict deadlines.
HEDIS Reviewer III / Project Coordinator
CVS Health / Aetna
01.2023 - 04.2023
- Conducted Medicare HEDIS reviews for compliant and non-compliant chart data.
- Annotated clinical records, abstracted measures, and verified coding accuracy.
- Entered results into QSHR, Cotiviti, KPN, and other audit systems.
- Tracked pending charts, followed up with providers, and ensured complete documentation for audit closure.
- Performed spreadsheet analysis, case management activities, and multi-system data validation.
Medical Records Auditor / Data Retrieval Specialist
CIOX Health
08.2011 - 09.2020
- Retrieved, scanned, and uploaded medical records through multiple EMR systems.
- Audited charts, reviewed labs, X-rays, face sheets, cytology results, and claims histories.
- Worked with Cerner, Centricity, NextGen, EClinicalWorks daily.
- Traveled to multiple sites, worked independently, and completed time-sensitive chart audits.
- Trained new staff; organized charts; exported, edited, and uploaded data to ECS systems.
- Assisted with coding verification, record abstraction, and quality documentation.
HEDIS Project Coordinator (Seasonal)
United Healthcare
01.2018 - 05.2020
- Retrieved medical charts nationwide and processed HEDIS pend assignments.
- Entered and validated data in Advantmed and additional client-specific systems.
- Conducted overreads for HEDIS measures and abstracted compliant results.
- Ensured accurate ICD-10 coding and supported data processing operations.
- Worked with multiple software platforms and IT systems in a fast-paced environment.
HEDIS Abstractor & Reviewer / Project Coordinator
General Dynamics
01.2017 - 05.2017
- Retrieved and abstracted medical records for Blue Cross Blue Shield projects.
- Entered data into MedManager and MedCapture databases.
- Utilized multiple hospital systems to gather and validate clinical information.
- Supported compliant and non-compliant data processing and ensured timely submissions.
Rehab Billing, Prior Authorization & Rehab Assistant
Canyon Vista Medical Center
11.2014 - 07.2015
- Performed new patient registration, insurance verification, medical billing, and collections.
- Processed prior authorizations (TriCare, BCBS, commercial plans).
- Scheduled evaluations and coordinated multi-disciplinary therapy appointments.
- Supported physical therapists with patient exercises, modalities, and equipment preparation.
- Managed charts, ICD-10 code verification, case management tasks, and claims follow-up.
Medical Assistant / Clinical Support
Kaiser Permanente
12.1996 - 09.2003
- Assisted in OB-GYN, Dermatology, Surgery, and multiple hospital departments.
- Supported procedures including myomectomy, hysteroscopy, ablations, colposcopy, biopsies, cystoscopy, and more.
- Performed EKGs, Holter monitors, stress tests, specimen preparation, wound care, and catheter assistance.
- Conducted charting, report preparation, ICD-9 coding, and medical terminology applications.
- Trained new medical assistants (40–60 days each).
- Handled front office duties including registration, billing, collections, and scheduling.
Education
AA - Business & Nutrition
Central Arizona College
01.2019
Skills
- Medical Chart Auditing & HEDIS Abstraction
- ICD-10 / ICD-9 Coding & Documentation Review
- Prior Authorization & Insurance Verification
- EMR Systems: Cerner, Centricity, NextGen, eClinicalWorks, Affinity, Epic, others
- Data Analysis & Quality Assurance
- Medicare Advantage, STARS, NCQA, CMS Audit Support
- Case Management & Data Integrity Review
- Medical Assistance & Clinical Procedures
- Medical Billing & Claims Resolution
- Project Coordination & Multi-System Navigation
- Microsoft Office (Excel, Word, Outlook, PowerPoint)
- CRM Systems & Advanced Computer Skills
- Problem Solving, Time Management, Team Collaboration
Accomplishments
Medical Assistant Certification
Real Estate License
82 credits towards AS and finishing degree fall 2026
Certification
Medical Assistance
ADDITIONAL STRENGTHS
- Quick learner & adaptable
- Strong written and verbal communication
- Excellent problem-solving abilities
- Team-oriented with leadership capability
- High attention to detail and accuracy
Languages
German
Native or Bilingual
Timeline
HEDIS Project Over reader
Optum
02.2025 - 01.2026
HEDIS Quality Specialist III / Project Coordinator
HTA
01.2024 - 03.2024
HEDIS Reviewer III / Project Coordinator
CVS Health / Aetna
01.2023 - 04.2023
HEDIS Project Coordinator (Seasonal)
United Healthcare
01.2018 - 05.2020
HEDIS Abstractor & Reviewer / Project Coordinator
General Dynamics
01.2017 - 05.2017
Rehab Billing, Prior Authorization & Rehab Assistant
Canyon Vista Medical Center
11.2014 - 07.2015
Medical Records Auditor / Data Retrieval Specialist
CIOX Health
08.2011 - 09.2020
Medical Assistant / Clinical Support
Kaiser Permanente
12.1996 - 09.2003
AA - Business & Nutrition
Central Arizona College