Victoria Dagostino

Nurse Abstractor/HEDIS Nurse Abstractor

Conduct remote reviews on charts and e Pass for proprietary CARA risk score accuracy projects for Medicare RRO and FRO I & II at industry-leading healthcare cloud-based technology platform service provider, while strictly maintaining patient confidentiality per HIPAA regulations.

Key Accomplishments:

• Perform CARA projects risk adjustment and HEDIS chart reviews for Medicare RRO and FRO, maximizing Centers for Medicare and Medicaid Services (CMS) payment amounts to Inovalon clientele while minimizing payment delays due to regulatory non-compliance.
Capture CMS-mandated payment model ICD-9 and ICD-10 diagnosis codes and RX HCC codes, further optimizing claims processing.

• Analyze Medicare outcomes utilizing The Healthcare Effectiveness Data and Information Set (HEDIS) tool encompassing over 80 measures.

• Conduct sophisticated Clinical Risk Group classification matrix adjustments for assignment of patients to exclusive groups based on historical clinical and demographic characteristics for optimal future allocation of health care resources.

• Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
• Coordinated with other healthcare team members to support Introduced changes to patient care plans based on regular evaluations and patient changes.
• Provided physical assessments, medication, and chronic disease management to home health patients.