Summary
Overview
Work History
Education
Skills
Timeline
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VICTORIA RANDOLPH

North Port,FL

Summary

As a healthcare professional, I prioritize meticulous attention to detail in all projects and communication while thriving in fast-paced collaborative environments.

Utilizes strong planning and organizational skills to manage resources effectively. I have experience in project management, clinical research, medical data analysis, and problem-solving in managed care, level I trauma, urgent care and outpatient centers.

Overview

9
9
years of professional experience

Work History

HEDIS Coordinator Tasked as Project Manager/SDCA Clinical Team

Centene Through Mindlance (Temp)
05.2025 - 12.2025
  • Supported the Pilot Team in end-end data analysis ensuring deliverables across the OH, IA, IL and MS markets were completed in a timely manner for 80+ provider groups.
  • Managed stakeholder communication acting as the primary liaison between the provider groups, health plans, SDT and the Retrieval Team.
  • Leveraging tools such as Q2C UI, Excel Spreadsheet and other MS suite tools to track data, manage tasks and report outcomes.


HEDIS Coordinator during Hybrid HEDIS MY2025/ Corporate EMR Team

Centene Through Mindlance (Temp)
12.2024 - 04.2025
  • Assisted the Corporate EMR team in the annual HEDIS Hybrid audit sitting at the top 5% of chart chasing productivity and accuracy.
  • Completed specials projects assigned by team leads conducting research to ensure priority care gap closure.
  • Proficiently utilized EPIC EMR system and HEDIS platforms such as QMRM, QCAT.


Patient Care Advocate/Quality Department

Centene Corporation (Temp to FTE)
12.2023 - 05.2024
  • Collaborated with Quality Practice Advisor team to improve provider performance in areas of Quality and Risk for the Wellcare health plan.
  • Educated providers on priority care gaps, and accuracy with CPT II coding.
  • Conducted member outreach in alliance with Medicare focused programs and initiatives such as VRI and Quality MAC committee to close priority HEDIS care gaps.
  • Assisted in the annual HEDIS Hybrid audit by working various projects, such as chart chases or abstracting etc., simultaneously as assigned.

Clinical Chart Abstractor

Esse Health
10.2021 - 10.2023
  • Reviewed 30-40 patient charts daily to find missed HCC and RxHCC codes. Compiled findings into a report for providers.
  • Researched hospital systems to collect patient data where information can be abstracted for future review.


Medical Records Specialist

Ciox Health/St. Louis University Hospital
07.2019 - 01.2021
  • Reviewed and processed 20-30 ROI requests daily to insurance companies, law offices, disability services, providers offices.
  • Performed quality checks to assure accuracy of the release, confidentiality, and proper invoicing.
  • Assisted in the processing of HEDIS Hybrid audits for reporting quality assurance.

Patient Access Representative

Mercy Hospital
06.2017 - 07.2019
  • Explained policies, procedures, or services to patients using medical and administrative knowledge.
  • Reviewed financial responsibility information, applied the proper coding, and collected payments.


Education

Certification of Proficiency in Clinical Coding -

St. Louis Community College
St. Louis, MO
05.2021

Skills

  • Microsoft Office Suite: Excel, Word, PowerPoint
  • Electronic Health Records: Epic (Advanced), Cerner, NextGen
  • ICD-10-CM, CPT, PCS, HCPCS coding systems
  • Analytic & Reporting Tools: Centene Clinical Action, Provider Analytics, QOT, QMRM, QCU UI, Power BI

Timeline

HEDIS Coordinator Tasked as Project Manager/SDCA Clinical Team

Centene Through Mindlance (Temp)
05.2025 - 12.2025

HEDIS Coordinator during Hybrid HEDIS MY2025/ Corporate EMR Team

Centene Through Mindlance (Temp)
12.2024 - 04.2025

Patient Care Advocate/Quality Department

Centene Corporation (Temp to FTE)
12.2023 - 05.2024

Clinical Chart Abstractor

Esse Health
10.2021 - 10.2023

Medical Records Specialist

Ciox Health/St. Louis University Hospital
07.2019 - 01.2021

Patient Access Representative

Mercy Hospital
06.2017 - 07.2019

Certification of Proficiency in Clinical Coding -

St. Louis Community College

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VICTORIA RANDOLPH