Microsoft Excel
Shirin Shah
Clinical Quality Consultant II
Orlando,FL
Summary
Dedicated and experienced health care professional with a 6+ years of risk adjustment, clinical quality, or healthcare quality improvement experience seeking a role of Risk Adjustment Business Consultant .
Overview
8
8
years of professional experience
9
9
years of post-secondary education
5
5
Languages
Work History
Clinical Quality Consultant II
WellMed Medical Management - United Health Group
Orlando, FL
04.2022 - Current
- Educated point of contact and providers from contracted clinics about HEDIS measures and HEDIS documentation guidelines
- Collaborated with leadership to develop strategy to improve provider's quality performance in order to help practice and provider achieve 4 stars
- Provided HEDIS education to providers in a pool in Clinic business review meetings. HEDIS /Quality improvement business review meetings related to STAR activities
- Acted as liaison and primary quality support to providers and clinics staff on improving scores to 4 stars
- Used datas and reports from tableau and various other sources to interpret scores to providers groups
- Attended cross functional meetings to update leadership on quality performance by communicating clinics barriers and to strategize on next action plan c
- Reviewed medical records to extract missing HEDIS measures and submit them via EPRG
- Applied coaching techniques and tools to support provider groups and provider in improving performance.
- Assist provider groups with identifying patients who are non adherent to medication and suggest available resources to assist patient compliance
- Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.
- Used excel and powerpoint to create presentations, flowcharts and graphs detailing data analysis results.
Clinical Quality Analyst
WellMed Medical Management - United Health Group
Orlando , FL
02.2016 - 04.2022
- 6+years of risk adjustment, clinical quality, or healthcare quality improvement leadership experience
- 6+ years experience with one or more of the following methodologies: management consulting, project consulting, busines s process consulting, risk management consulting
- Conducted medical chart review to identify risk adjustable diagnosis as established by CMS guidelines
- Strong time management, project management, organizational, research, analytical, negotiation, communication, and interpersonal skills
- Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), including experience running web based meetings.
- Ability to lead people and get results through others
- Ability to organize and manage multiple priorities
- Suggested risk adjustable HCC codes/diagnosis to Wellmed and contracted providers from various markets within Florida
- Conducted education sessions for several providers/ medical groups on identifying and documenting risk adjusted diagnosis based on ICD 10 and CMS guidelines
- Educated providers on best practices in documentation to improve patient care, performance, reach their goals and receive highest reimbursement.
- Collaborated with DATARAP to stay updated in latest changes in risk adjustment and provided updates and education to providers /providers groups
- Provided regular updates to team leadership on providers performance, improvements and barriers
- Used excel and powerpoint to create presentations, flowcharts and graphs detailing data analysis results.
- Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), including experience running Webex and Teams meetings.
HEDIS Specialist
Central Florida Internists
St.Cloud , FL
05.2014 - 05.2015
- Improving and managing quality of healthcare services provided to seniors and community by monitoring HEDIS interim.
- Coordinated and designed plan within four locations of growing medical practice to ensure quality control and HEDIS measures were being met on timely manner.
- Contributed in increasing star rating and RAF Score of medical practice and physicians.
- Worked closely with United health care and Wellmed insurance company and its staff members to complete HEDIS measures.
- Trained other staff members on HEDIS .
- Developed strong professional rapport with various providers, office managers and united healthcare providers and staff members to ensure quality patient care services to all members.
Education
M.D. - Medicine
Universidad Iberoamericana (UNIBE)
Santo Domingo, Dominican Republic 09.2003 - 06.2009
Some College (No Degree) - Premedicine
Adventist Hospital College of Health Science
Orlando, Florida 01.2002 -
General Studies
Valencia Community College
Orlando, Fl 05.2001 -
High School Diploma -
Cypress Creek High School
Orlando, FL 06.1997 - 06.2000
Skills
Teambuilding
Accomplishments
- Helped achieved providers reach their risk adjustment goal by being very specific about the location of documentation and making it very simple for the providers to find the information needed to attest to a diagnosis.
- Simplifying reports to make it very user friendly for providers and staff to help them achieve their goal.
Affiliations
American Red Cross
American Heart Association
American Medical Student association
American Diabetes Association
Casa Rosada
Software
Microsoft powerpoint
Microsoft word
Service now
Tableau
Salesforce
Smartsheets
EPRG
IKA
Various Electronic medical records
Timeline
Clinical Quality Consultant II
WellMed Medical Management - United Health Group
04.2022 - Current
Clinical Quality Analyst
WellMed Medical Management - United Health Group
02.2016 - 04.2022
HEDIS Specialist
Central Florida Internists
05.2014 - 05.2015
M.D. - Medicine
Universidad Iberoamericana (UNIBE)
09.2003 - 06.2009
Some College (No Degree) - Premedicine
Adventist Hospital College of Health Science
01.2002 -
General Studies
Valencia Community College
05.2001 -
High School Diploma -
Cypress Creek High School
06.1997 - 06.2000
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