Nichole Johnson

• Performed medical record reviews and entered findings into the abstraction tool
• Reviewed assigned medical records, abstracted relevant clinical data, over-reading clinical data, and reported to a superior on whether healthcare provision standards were being met
• Responsibilities included reviewing medical records thoroughly and using clinical judgement to extract data to help close HEDIS Care Gaps
• 40-60 records a day depending on the measure I worked on
• Maintained accuracy and productivity rates >95%

Functioned as a remote HEDIS nurse and performed medical record analysis using electronic medical records.

Initiate member outreach and survey support, compile information and prepare reports for management, utilize findings and trends to improve efficiency as well as customer satisfaction.

Accomplished numerous tasks including data abstraction from charts of specific indicators, inputted and submitted data via computer program.

100% accuracy on medical record review and abstraction.

Over-read 100% of outside vendor abstractions per client protocols.

Maintain HIPPA regulations for consumer privacy and complete tasks in a timely manner, ensure compliance with NCQA, federal, state and other regulatory agency standards.

• Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate code for procedures.
• Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.

• Collaborated with interdisciplinary team of professionals, as well as patients and families, to determine appropriate treatment options.
• Gathered community resources and coordinated referrals to obtain services.
• Arranged for medical, mental health or substance abuse treatment services according to individual needs or court orders
• Refer patient, client, or family to community resources to assist in recovery from mental or physical illness and to provide access to services such as financial assistance, legal aid, housing, job placement or education.
• Advocate for clients or patients to resolve crises.
• Utilize consultation data and social work experience to plan and coordinate client or patient care and rehabilitation, following through to ensure service efficacy.
• Plan discharge from care facility to home or other care facility.

• Implemented healthcare systems for patient status monitoring, quality tracking and home care management.Conduct comprehensive medical record reviews to identify and extract relevant data for HEDIS measures.
• Collaborated with healthcare providers and supported staff to obtain necessary documentation for HEDIS reporting.
• Analyzed and interpreted medical records to ensure compliance with HEDIS standards.
• Entered and maintained data in HEDIS software systems accurately and efficiently.
• Identified opportunities for improvement in documentation and coding practices to enhance HEDIS scores.
• Collaborated with cross-functional teams to develop and implement strategies to improve quality measures.
• Stayed updated on current HEDIS guidelines and ensured adherence to all regulatory requirements.

• Applied comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
• Selected and assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).
• Adhered to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management code to ensure ethical, accurate, and complete coding.

• Steadily advanced through a series of progressively responsible positions and handpicked for multiple high-impact projects.
• Trained and floated to all departments, performing direct patient care encompassing ER, ICU, chemotherapy, med-surg floor, same day surgery, critical care, and clinic functions such as triage, phones, and prior authorizations.
• Assisted physicians in performing invasive procedures, advanced cardiac life support, and cardiovascular interventions such as cardioversion and PTCAs (percutaneous transluminal coronary angioplasties).
• Cared for patients across the lifespan affected by illness and injuries including trauma, cardiac arrest, strokes, and sexual assault.
• Maintained hospital equipment such as ventilators, feeding tubes, catheters, CVVHD, critical drips, and heart monitors.
• Functioned as discharge planner and case manager in 2013 tasked with processing claims for healthcare benefits; reviewed claims to ensure validity and coordinated payments.
• Responded to callers’ questions regarding health plan, billing issues, prior authorizations, refills, and documentation/forms needed for medical reasons.
• Partnered with primary care physician and other medical providers to coordinate timely treatments, collateral services, and service authorizations.
• Formulated individualized person-centered plans for consumers to meet community integration and service coordination goals.
• Chosen to participate in two-month relicensing project in 2012 for behavioral health unit to practice in designated building.
• Functioned as Quality Compliance Officer from 2011 to 2012 participated in statewide adverse health events reporting system and commissioned multiple patient safety calls to action within the organization.