Summary
Overview
Work History
Education
Skills
Timeline
CORE COMPETENCIES
Generic

Tiffany Mackey

Georgia,GA

Summary

Clinical Quality Analyst with 11+ years of experience in HEDIS, Stars, and Medicare Advantage programs. Recognized SME in NCQA specifications, provider engagement, and care-gap closure strategies. Skilled in converting complex data into actionable insights using SQL, Power BI, and Tableau to drive quality improvement and regulatory compliance. Proven ability to train and coach providers and teams, enhancing productivity and patient outcomes. Currently pursuing a B.S. in Healthcare Management (4.0 GPA)

Overview

11
11
years of professional experience

Work History

Clinical Quality Analyst – SME (Per Diem)

Optum
12.2022 - Current
  • Serve as SME on NCQA HEDIS specs for retrospective, prospective, and admin measures, support abstraction and over-read teams.
  • Conduct support audits and QA checks to ensure accuracy in Medicare Advantage chart abstraction.
  • Build SQL/Power BI/Tableau dashboards to track trends and target interventions that lift Stars performance.
  • Coach 1:1 via QOGA/Coach Tracker; trained 50+ staff, reducing documentation errors and boosting productivity.
  • Partner with leadership to resolve logic issues and improve MRR tool workflows; increased HEDIS/CMS compliance 15%.
  • Developed and maintained quality assurance procedure documentation.

HR Manager

Bright Future Kiddie Care
08.2019 - 12.2022
  • Led HR operations across 3 sites (150+ staff): recruitment, onboarding, compliance, scheduling, and ADP payroll/timekeeping.
  • Managed background checks/BLAs and coordinated fingerprinting (IdentoGo) to meet licensing requirements.
  • Led decision-making and implementation of HR policies, procedures, programs and functions.
  • Maintained company compliance with local, state, and federal laws, in addition to established organizational standards.
  • Facilitated onboarding sessions and on-the-job training for new hires, bolstering employee job position knowledge and skillset.

Clinical Practice Performance Consultant – SME

UnitedHealth Group
08.2014 - 08.2019
  • Drove HEDIS performance with provider practices via training, workflows, and care-gap alerts prior to visits.
  • Coordinated across clinical/admin teams for screenings, referrals, BH, and social services programs.
  • Monitored metrics and executed action plans that produced 3+ point gains in Star Ratings at multiple practices.
  • Created/updated job aids and best-practice materials aligned to NCQA standards; mentored new staff.
  • Boosted client performance by conducting in-depth assessments and identifying areas for improvement.

Education

B.S. - Healthcare Management & Administration

DeVry University
Naperville, IL
03.2026

Skills

  • Clinical Quality & Compliance: HEDIS Abstraction & Chart Review, Medicare Advantage & Risk Adjustment, Provider Engagement, Regulatory Compliance (NCQA, CMS, CAO, ACO, IPA)
  • Data Analytics & Performance Tools: SQL, Power BI, Tableau, Ratemax, Ratelifft, QMRM, ILEAD, ISET, Coach Tracker, QOGA
  • Healthcare & Operations Systems: Epic, Centricity, eClinicalWorks, Inovalon, CIOX, Facets, OnBase, Doc360, One Healthcare, Datavant, NavaNet, Advantmed; HR Operations (ADP Payroll, Timekeeping, Benefits, Scheduling, Compliance Oversight)

Timeline

Clinical Quality Analyst – SME (Per Diem)

Optum
12.2022 - Current

HR Manager

Bright Future Kiddie Care
08.2019 - 12.2022

Clinical Practice Performance Consultant – SME

UnitedHealth Group
08.2014 - 08.2019

B.S. - Healthcare Management & Administration

DeVry University

CORE COMPETENCIES

  • HEDIS Abstraction & Over-read
  • Star Ratings Optimization
  • Medicare Advantage & Risk Adjustment
  • Provider Engagement & Training
  • Care-Gap Closure Strategies
  • Performance Reporting & Process Improvement
  • Compliance: NCQA, CMS, ACO, IPA

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Tiffany Mackey