Robyn Updite

• Collaborated with cross-functional teams to develop and implement targeted solutions for identified quality issues, ensuring continuous improvement.
• Identified process inefficiencies through meticulous data analysis, leading to streamlined operations and increased productivity.
• Ensured compliance with regulatory requirements by meticulously reviewing documentation and maintaining accurate records.
• Developed and maintained quality assurance procedure documentation.
• Collaborated on HEDIS measures including COPain, COLO, A1C, OSW, TRC, KED, among others.

Conducted medical necessity reviews for Medicare claims, ensuring compliance
with CMS and NCQA standards.
• Assessed provider documentation to verify accuracy, necessity, and coding
compliance for reimbursement.
• Prepared Independent Review Entity (IRE) packets for submission to Maximus for
appeals processing.
• Facilitated teleconferences and provider education sessions on compliance and
quality assurance measures.
• Adapted to multiple Medicare lines of business (Part A, Part B, and DME) for
claims adjudication.

• Managed clinical intake processes, performing insurance verifications and
• Authorizations.
• Ensured compliance with State, Title 22, and JCAHO regulations in home health
• Coordinated patient referrals, scheduling, and home medical equipment orders to
• Assisted in telehealth triage and patient inquiries, ensuring timely service delivery.
• Completed intake assessment forms and filed clients' charts.
• Maintained strict confidentiality of patient information, adhering to HIPAA guidelines and company policies.
• Collaborated on HEDIS measures including COPain, COLO, A1C, OSW, TRC, KED, among others.