YOLANDA ROBINSON

• Managed vendor performance to maximize profitability and achieve financial objectives.
• Identified cost-effective vendors and set up favorable contracts, saving per year.
• Optimized organizational systems for payment collections, AP/AR, Oracle deposits and recordkeeping.
• Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
• Maintained primary relationship accountability for clients, overall servicing responsibility and client satisfaction to maximize profitability of client relationships.
• Developed internal requirements which complied with program standards to minimize regulatory risks and liability across program.
• Track project milestones and tasks to report to management and client
• Assist with Implementation and Operations

• Health plan experience assisting providers and health systems manage care of over 10,000 Medicare Advantage lives, by providing strong education of value-based care principles and health policy landscape
• Providing strategic considerations and recommendations internally and to clients of Medicare Advantage Plan
• Track project milestones and tasks to report to management and client
• Educate and train clients, CMO and physicians on Comprehensive Visit, Clinical Performance, Documentation, RAF scores, STARS and Quality Metrics)
• Invite vendors as appropriate (Home Health, Medical Nutrition Therapy, Behavioral Health, etc.) to present best practices
• Builds effective working relationships with internal and external SMEs, client, physicians, and healthcare partners
• Review analytic reports to identify improvement activities specific to ACO and Medicare Advantage Plan overall performance as well at individual provider/TIN level
• Work with client to develop strategies around target areas for improvement
• Identifies process improvement gaps and creates solutions by developing data driven workflows to improve physician performance against value-based contract measures
• Working knowledge of clinical quality metrics such as RAF, HCC, HEDIS, STARS, NCQA
• Finds trends, predict issues, highlight critical areas, and develop corrective action plans
• Implemented best practice standards for billing resulting in substantial reduction of accounts receivable delays.
• Increased patient satisfaction scores within 6 months.
• Identify and manage members with moderate or rising risk conditions and align intervention to members health condition to control costs and improve quality
• Measure financial and quality outcomes of population health and condition management programs

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• Improved quality processes for increased efficiency and effectiveness for ACO/Medicare Plan
• Track project milestones and tasks to report to management and client (Internal and External)
• Creates, updates, and enhances materials to assist physicians and staff on Risk Adjustment Programs and HEDIS, and CMS STARs
• Work closely with clients and SMEs to confirm quality and timeliness of work
• Managed oversight and direct performance of Medicare Advantage program to include HEDIS, CMS Reporting, QI Reporting, and related processes
• Collaborating across departments to implement interventions to improve performance for health outcomes such as HEDIS/Stars
• Maintain current knowledge of HEDIS, CMS STARs measure specifications and communicate changes to internal teams
• Collaborates with analysts and other department members to customizes education and education materials for various audiences including support staff, primary care physicians, specialists, billers, coders, and employees of other healthcare delivery systems
• Establish and maintain effective and cooperative working relationship with internal staff, physician practices and other external contacts
• Understand principles of Risk adjustment, CMS, HEDIS, NCQA, Health Plan Quality Standards related to HEDIS and STARs measures
• Perform monthly provider validation via web portal
• Help onboard external members from AHA program, including coordination with compliance and credentialing.

• Review Quality data and reports
• Assisted with development of care guidelines for physicians to improve EMR documentation and Medicare cost savings
• HEDIS review and reporting
• Assist with performance management through delivery and management of physician reports, providing feedback and education, and guiding actionable initiatives from data
• Access physicians EMR's and review clinical information on Medicare beneficiaries to assess gaps in care
• Complete and reviewed data analytics for GPRO reporting for Medicare nationally recognized quality measures
• Review with physician's staff high risk disease management patient care and ways to improve quality of care
• Review and updated policies regarding accountable care under guidelines of Medicare
• Assist with network management strategy, including, specialty referral strategies, co- management agreements, physician meetings infrastructure (POD) and access initiatives
• Train and educate staff and physicians on workflow, EMR, GPRO
• Health Services for Children with.
• Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals.

• Chart audit and review clinical documents to verify accuracy
• Sustained quality standards by performing routine medication audits and upholding internal and industry best practices
• Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.

• Collect and aggregate clinical data, analyze clinical and operational results
• Perform comprehensive pre-admission clinical and fiscal assessments
• Monitor the Admission Budget
• Monitor Daily Census, E Discharge and ECIN
• Develops strategies to maximize admissions including daily contact with potential referral sources including but not limited to hospitals, physicians, insurers, case management companies and health care agencies
• Strategized and implemented methods for streamlining processes, controlling costs and modernizing operations
• Oversee 150+ employees.

• Schedule emergency or same day appointments based on telephone assessments
• Proficient in ALTA and CHCS1 AND 2
• Experienced with Tricare and the Tricare referral process
• Documented services discussed and provided details in electronic medical records
• Analyzed discussed symptoms with established protocols to determine patient acuity
• Reviewed medical chart and requested appointments, prescriptions and consultations for urgent needs.

• Work in collaboration with nurse educator and Clinical Operations Specialist to achieve Targets for Quality Improvement
• Assist with projects to improve strategies
• HEDIS and GPRO review, Supervising and reviewing nursing staff (staff of 100+)
• Administered executive supervision, exercising independent judgment to select proper course of action in policies and procedures
• Oversaw new nursing employee orientation process, including explanation of personnel policies and individual duties.