YAIMA PELLON

. Responsible for working with Medicare plans to achieve the required stars by closing insurance gaps

. Responsible for making phone calls to the Medicare patients to make sure they pick up medication at the pharmacy to identified medication adherence

. Daily review next day of assigned provider’s Cap patients.

. Daily review next day Quality actions found previous day Caps patients.

. Responsible for coordination of care regarding quality gaps measures pending with our office managers and QI director.

. Responsible for coordination of any Quality gaps measures events with QI director.

. Responsible for coordination of Quality Chart review request from insurance companies in the offices.

. Responsible to coordinate with office managers any medical records from Hospital, specialist visit and/or SNH for office follow up missing in chart.

. Identified and follow up with billing department medical assistant’s documentation errors regarding quality measures.

. Send to QI Director Spreadsheet report on time for process.

. Responsible for keep our EHR system (ECW ) up to date as: • Identified and correct any patient’s information error. • Quality Spreadsheet • CDSS/Alerts • Quality Global Alerts • Arcadia Quality Measures Portal.

• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Entered and processed patients' prescriptions into internal system.

• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Entered and processed patients' prescriptions into internal system.
• Completed paperwork, entering prescription and insurance or billing information into patient profiles.
• Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
• Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.

As member of the coding company I reviewed and assess documentation and accurately translates HCCs into the appropriate ICD code from medical records. I extracted data for Health Plan reports and inputs data collected from HCC programs. I assisted in obtaining medical records from Providers to support audits requested by Health Plans

• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Resolved third-party billing, computer system and customer service issues.
• Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
• Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Entered and processed patients' prescriptions into internal system.