Summary
Overview
Work History
Education
Skills
Custom
Timeline
Generic

Ruqaiya Steele

Summary

Experienced healthcare professional with over 13 years at Optum United Healthcare supporting Medicare and Medicaid populations through case management, quality reporting (HEDIS, RADV), and CMS-mandated chart retrieval programs. Adept in cross-functional roles, including Universal Agent support for physicians, compliance-driven documentation, and assisting members with enrollment in state and federal programs. Strong knowledge of healthcare operations, claim systems, and government healthcare guidelines.

Overview

15
15
years of professional experience

Work History

Provider Resolution Specialist

Optum
Hollywood
02.2024 - 07.2025
  • Coordinated with healthcare providers to obtain and review medical records for RADV, HEDIS, and Chart Retrieval programs.
  • Verified and resolved data discrepancies to ensure accurate risk adjustment and quality reporting.
  • Supported compliance with CMS guidelines by facilitating timely documentation and record submissions.
  • Communicated effectively with providers to address documentation issues and improve data quality.

Universal Agent/Case Coordinator

Optum
Hollywood, FL
03.2010 - 02.2024
  • Assisted Medicare and Medicaid members in applying for state and federal programs, including the Medicare Savings Program (MSP), Medicaid, and Low-Income Subsidy (LIS).
  • Educated members on their benefits and ensured understanding of their Medicare/Medicaid entitlements and available support resources.
  • Maintained detailed and accurate documentation in compliance with HIPAA and CMS regulations, using internal platforms such as MMS.
  • Monitored program participation and followed up on pending applications to ensure completion and proper processing.
  • Facilitated resolution tasks, including outbound and inbound communication to collect supporting documents.
  • Ensured adherence to HIPAA guidelines and company policies while handling sensitive member health information.

Education

High School Diploma -

Miami Senior High
Florida

Skills

  • HIPAA compliance
  • HEDIS (Healthcare Effectiveness Data and Information Set)
  • RADV (Risk Adjustment Data Validation)
  • Chart Retrieval and Documentation Review
  • CMS (Compliance and Quality Reporting)
  • Member and Provider Support
  • Case Management Assistance
  • Medicare/Medicaid Programs Knowledge

Custom

Tools and Systems

  • Facets, Amardi, Doc360, iLead, EPIM, Focus and CIRRUS

Timeline

Provider Resolution Specialist

Optum
02.2024 - 07.2025

Universal Agent/Case Coordinator

Optum
03.2010 - 02.2024

High School Diploma -

Miami Senior High

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Ruqaiya Steele