Your Name

• Referred to HEDIS guidelines approved by NCQA in project year regarding specific measurements.
• Researched medical records that were assigned for appropriate measurements.
• Making sure the quality needs are met in a timely manner as a team member.
• Prioritized and organized tasks to efficiently accomplish service goal.
• Familiar with Reveleer Platform Software
• Demonstrated a strong background in researching medical records for proper medical terminology, correct laboratory screenings, and/or procedural screenings as necessary.
• Researched multiple measurements as required base on project needs.
• Volunteered over-time as requested to meet the needs for project year.
• Demonstrated leadership by making improvements to work processes and helping to train others.

• Maintain HIPPA regulations for consumer privacy and complete tasks in a timely manner, ensure compliance with NCQA, federal, state and other regulatory agency standards
• 98% accuracy on medical record review and abstraction
• Conduct reviews of the data/records to ensure abstraction accuracy of clinical data elements for HEDIS reporting.
• Weekly team meetings to discuss progress, and overall percentage comparisons on status of project with records collected
• Performed Overreads and Medical Record Review Validations for CIS, IMA, EED measures.
• Worked primarily with Medicaid charts for Optum and United Health Group.
• Worked with Ciox abstraction software platform.
• Exceeded chart expectation of 40-50 chart per day, while maintaining a 98% accuracy.
• Familiar with ISETS, Facets, DOC360 and Maestro.

• Determined correct ICD-10 and CPT codes for use in medical record.
• Input details about patient histories, physical examinations, medications and other information into physical or electronic charts.
• Followed clinicians throughout shift in high-volume, busy environments.
• Received dictation and created high-quality documents.
• Evaluated charts, documents and orders and made timely corrections.
• Reviewed account information to confirm patient and insurance information is accurate and complete.
• Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
• Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate code for procedures.
• Maintained understanding of all active patients in order to facilitate workflow.
• Used EHR system (EPIC) to manage patient records, always maintaining patient confidentiality according to HIPAA standards.
• Recorded, stored and reported medical coding information to create statistics of healthcare encounters.

General Surgery/Bariatric

• Monitored medical supply levels to confirm sufficient stock, promptly placing replenishment orders before depletion.
• Secured patient information and maintained patient confidence by completing and safeguarding medical records.
• Led patients to exam rooms, answered general questions and prepared patients for physician by explaining process.
• Collected forms, copied insurance cards and coordinated patient information for billing and insurance processing.
• Educated patients about medications, procedures and physician's instructions.
• Verified appointment times with patients, preparing charts, pre-admission and consent forms.
• Organized charts, documents and supplies to maintain team productivity.
• Efficiently performed insurance verification and pre-certification and pre-authorization functions.
• Batch-scanned and indexed patient charts to improve data availability while maintaining security.
• Conducted insurance verification and pre-certification and pre-authorization functions.

Internal Medicine

• Organized charts, documents and supplies to maintain team efficiency.
• Assessed, documented and monitored vital signs for more than 60 patients per day.
• Interviewed patients to verify information, record medical history and confirm purpose of visit.
• Contacted pharmacies to submit and refill patients' prescriptions.
• Monitored medical supply levels to confirm sufficient stock, promptly placing replenishment orders before depletion.
• Contributed to office operations by triaging patients by severity of medical complaint.
• Educated patients about medications, procedures and physician's instructions.
• Conducted insurance verification and pre-certification and pre-authorization functions.
• Interacted closely with practitioners, nurses and patients and used effective interpersonal, active listening and communication skills.
• Rendered high level of support to stressed patients prior to procedures, offering comfort and listening ear.