Tominka Thrash

· Gathers appropriate information to make requested contractual and demographic updates and changes related to provider data in the systems of record in an accurate, complete, and timely manner.

· Resolves escalated provider issues and serves as a senior resource to the department and other internal customers.

· Ability to work under pressure to produce high-quality work with defined turnaround time goals while managing and sustaining positive provider relationships.

· Conducted primary source verifications such as background checks, and board certifications, Obtained NPI numbers for providers and facilities and updated existing profiles.

· Perform QA Reviews on all medical records to ensure records meet CMS and HHS documentation requirements as well as retrieve medical records that meet specific NCQA/ STARS requirements.

· Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records and setup onsite medical records visits.

· Collaborate with other business areas in problem-solving, solution development strategic planning, and decision-making while following all laws and regulations associated with CMS STAR Program, HEDIS quality metrics, and AHRQ. Perform multiple projects in a matrix organization while proving success in managing projects.

● Reviewed Medical Disability Examination (“MDE”) reports and Disability Benefits Questionnaires (“DBQs”) for accuracy and consistency with the DBQ as well as ease follow-up to obtain any missing information to ensure reports are by Department of Veterans Affairs (the “VA”) guidelines.

● Ensures each report meets internal quality requirements and the VA's strict rating requirements before sending it to the VA.

Implements procedures necessary to have DBQ reports complete and promptly sent to the VA.

● Served as a liaison between the various internal departments, practitioners, and veterans professionally and courteously while keeping privacy and confidentiality.

● Perform daily maintenance to queue to address every case assigned to ensure progression toward completion.

● Aided with coordination of transitional care to reduce emergency care use by $1.3 million during FY19 and FY20 EHN.

● Generated over 135,000+ dollars in departmental revenue through gap closure, Annual Wellness Visits, and the coordination of post-hospitalization follow-up appointments.

● Developed Standards of Operations and departmental workflows to promote continuous quality improvement within the department while showing areas of improvement to increase workflow efficiency and standardization.

● Collaborated with insurance payers to find high-risk populations in efforts to reduce healthcare costs, promote health education, and maximize gap closure.

● Collaborated with members of an interdisciplinary care team to develop strategic plans to address gap coverage.

● Reviewed and analyzed quality metrics reports of health plan payers and used current ratings to implement a strategic plan of metric improvement.

Evaluated competency of clinical staff, documenting performance, and recommending improvements while performing chart audits for all reporting of quality metrics

• Assisted with routine checks and diagnostic testing by collecting and processing specimens.
• Taught patients about medications, procedures, and care plan instructions.
• Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
• Directed patients to exam rooms, fielded questions and prepared for physician examinations.

• Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
• Collected and documented patient medical information such as blood pressure and weight.
• Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history.
• Sanitized, restocked, and organized exam rooms and medical equipment.