Olakunle Balogun

SENIOR HEDIS ABSTRACTOR/OVERREADER

CVS

01.2019 - 06.2024

Conducted thorough medical records reviews and effectively collected and analyzed data.
Abstracted data from multiple records and extracted pertinent information.
Multitasked and resolved issues as they arose.
Ensured compliance with HIPAA regulations and adhered to NCQA, federal, state, and other regulatory standards.
Achieved a high level of accuracy (96%) in medical record review and abstraction.
Utilized CPT4, ICD-9, and ICD-10 codes according to HEDIS Technical Specification requirements.
Applied knowledge of codes for services based on diagnoses and procedures.
Assisted in data collection, entry, and report generation to support Quality Improvement (QI) initiatives.
Located specific claim data for measures within designated time frames.
Worked on the EMR team to retrieve medical records remotely from provider systems.
Conducted reviews of member records and input collected results into databases.
Managed high volumes of telephonic interactions with provider offices.
Consistently referenced HEDIS measures guidelines and kept abreast of annual changes.
Conducted interdepartmental inter-rater reliability audits.
Supported the Director of QI in preparing for audits by regulatory agencies and review organizations.
Used real-time care gap information to manage assigned populations.
Demonstrated expertise in abstracting HEDIS measures such as COA, TRC, CDC, CBP, PPC.
Incorporated CPT II codes to enhance detail and reduce medical record requests.
Maintained strict adherence to organizational policies and standards.