Victoria Adejokun
Houston,TX
Summary
Experienced and dedicated Registered Nurse with 29 years of experience in the healthcare insurance industry, including 9 years of clinical experience in patient care. Extensive knowledge of MS Office to maintain analytical and workflow efficiency. Seeking a remote position as HEDIS Nurse with an established HIPPA-compliant home office with a locked door and filing cabinet.
Overview
11
11
years of professional experience
Work History
HEDIS Abstractor
Healthcare Support Staffing
01.2021 - 05.2021
- Referred to HEDIS guidelines, approved by NCQA, to enter specific measures, if noted in medical record.
- Reviewed electronic medical records to confirm specific measures have been met.
- Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
- Examined and verified [Number] titles weekly.
- Provided support in obtaining records from outside sources to complete chart for patient care.
- Demonstrated keen attention to detail when reviewing legal descriptions, deed transfers, mortgages, judgments, and other records pertaining to the title of properties.
- Streamlined abstracting processes for increased efficiency and productivity by implementing innovative research techniques.
- Enhanced communication with clients by providing timely updates on project status and addressing inquiries promptly.
Epic Ambulatory Consultant
CareNational Healthcare Services, Anthem Blue Cross
01.2020 - 09.2020
- Reviewed prior authorization requests for scheduled surgeries, outpatient procedures, clinical appropriateness, and medical necessity.
- Reviewed plan language to determine benefit coverage and reviewed medical policies to determine if clinical submitted met criteria.
- Communicated with Clinical Medical Director for potential denials or questionable medical necessity cases.
- Ensured compliance with relevant industry regulations by staying up-to-date on best practices related to electronic health record management within an ambulatory care context.
- Played a vital role in project teams by providing expert guidance on the implementation of Epic Ambulatory systems within various healthcare settings.
- Collaborated with interdisciplinary teams to develop customized templates and reports in response to organizational needs.
- Increased adoption rates of the Epic Ambulatory application through comprehensive training and support for end users.
- Assisted clients with pre-implementation planning activities, including workflow analysis and optimization recommendations for the transition to Epic Ambulatory systems usage.
- Maintained servers and systems to keep networks fully operational during peak periods.
- Responded to customer inquiries and provided technical assistance over phone and in person.
HEDIS Abstractor
United Healthcare
09.2016 - 12.2019
- Reviewed unpaid medical claims for coding accuracy, appropriateness and medical necessity.
- Reviewed plan language to determine benefit coverage.
- Reviewed medical policies to determine if clinical submitted meets criteria under medical policies.
- Communicated with Medical Director for questionable medical necessity cases.
- Examined and verified [Number] titles weekly.
- Provided support in obtaining records from outside sources to complete chart for patient care.
- Assisted in preparation of title insurance policies and title commitments.
- Maintained strict compliance with industry regulations and guidelines while performing comprehensive abstract research.
- Minimized errors in documentation through meticulous proofreading before submitting completed work products to clients or team members.
Epic ClinDoc Consultant
Memorial Hermann Hospital
05.2014 - 06.2016
- Pre-authorized outpatient services include home health, PT/OT, DME, outpatient procedures, and home infusion/IV medications. Pre-authorized inpatient pre-services such as surgical procedures and other inpatient diagnostic procedures.
- Communicated with Medical Director for potential denials or questionable medical necessity cases.
- Identified and referred cases to Case Management, when appropriate.
- Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
- Worked closely with subject matter experts to develop solutions and improvements for clinical systems.
- Incorporated quality improvement and safety-enhancing methodologies and tools to improve workflow processes,
- Applied knowledge, data, information and workflow to develop evidence-based models for health information technology solutions.
- Worked with product engineering team to define clinical requirements and assist with testing.
- Developed and updated health information systems and interfaces.
- Spearheaded efforts to integrate telehealth services into existing workflows, enabling clinicians to better serve remote patients.
- Enhanced clinical documentation quality through comprehensive staff training on Epic ClinDoc software.
- Led, facilitated, and attended focus groups and meetings to strategize workflow issues.
- Implemented healthcare systems for patient status monitoring, quality tracking and home care management.
- Served as liaison between end-users and health IT team.
- Resolved problems, improved operations and provided exceptional service.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Developed strong communication and organizational skills through working on group projects.
- Worked effectively in fast-paced environments.
Epic Ambulatory Consultant
LewisGale Hospital
09.2010 - 05.2014
- Reviewed Medicare inpatient charts to identify potential gaps in physician documentation.
- Placed queries in electronic charts for clarification of documentation by physicians.
- Attended daily ICU rounds with physicians for documentation opportunities.
- Reconciled cases after discharge to accurately reflect DRG assignment with final coding summaries.
- Collaborated with team members to share knowledge and keep workflow moving smoothly.
- Enhanced patient care by ensuring accurate and complete medical records through timely and efficient documentation practices.
- Expertly transcribed medical reports for variety of physicians in hospital setting.
- Troubleshot and resolved technical issues to maintain productivity and quality of work.
- Used medical center hardware and software to produce required reports.
- Managed electronic clinical documentation and uploaded changes or updates using [Software].
- Audited quality and performance procedures by reviewing processes and charts at [Number] facilities.
- Collaborated with interdisciplinary teams to develop customized templates and reports in response to organizational needs.
- Developed strong relationships with key stakeholders, fostering trust and open communication channels throughout project lifecycles.
- Ensured compliance with relevant industry regulations by staying up-to-date on best practices related to electronic health record management within an ambulatory care context.
- Played a vital role in project teams by providing expert guidance on the implementation of Epic Ambulatory systems within various healthcare settings.
Education
Associate of Applied Science - Nursing
Excelsior, University of New York
Albany, NY04.1998
Practical Nursing Diploma - Nursing
Trident Technical College
Charleston, SC08.1996
Bachelor of Arts - Religion/English
Charleston Southern University
Charleston, SC08.1984
High School Diploma -
First Baptist Church School
Charleston, SC05.1980
Skills
- Extensive experience with Milliman Guidelines
- Working experience with Integral
- Trained new employees
- Reliable & trustworthy
- Critical thinking
- Extensive experience with Microsoft Office
- Analytical
Affiliations
- Phi Theta Kappa Honor Society, Omega Chapter, Member #2608186
Timeline
HEDIS Abstractor
Healthcare Support Staffing
01.2021 - 05.2021
Epic Ambulatory Consultant
CareNational Healthcare Services, Anthem Blue Cross
01.2020 - 09.2020
HEDIS Abstractor
United Healthcare
09.2016 - 12.2019
Epic ClinDoc Consultant
Memorial Hermann Hospital
05.2014 - 06.2016
Epic Ambulatory Consultant
LewisGale Hospital
09.2010 - 05.2014
Associate of Applied Science - Nursing
Excelsior, University of New York
Practical Nursing Diploma - Nursing
Trident Technical College
Bachelor of Arts - Religion/English
Charleston Southern University
High School Diploma -
First Baptist Church School
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