Vericka Walker

Provide administrative assistance and coordination for projects initiated by the Quality Improvement department including medical record abstraction related to the Star-rating, HEDIS, and Medicare HCC efforts. Promote a team environment and positive work environment while under the pressure of meeting deadlines and daily quotas. Coordinate mass mailings and mass record requests via fax, filing, scheduling, obtaining copies of medical records, phone follow-up, tracking, and data entry. Outreach to members to ensure there are no barriers in receiving health care and assist as needed.

Reviewed and audited patient clinical chart, telephonic case management with hospital discharge planning to SNF. Evaluated medical necessity for patient care. Determined LOC for the purpose of transitioning patient to skilled nursing facility, advocate and liaison between patient, family and care managers.

• Coordinated, completed, and updated management on all HEDIS processes and results
• Organized and maintained a plan of action to improve HEDIS scores
• Requested and evaluated reports for member compliance and improvement opportunities for each HEDIS measure
• Ensured compliance by conducting quality audits and maintaining all data and process controls