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Click here or scroll down to respond to this candidateCandidate's Name
(Palm Bay, FL)Summary:Sandy has 5+ years of experience as a SOS / HEDIS, Project Coordinator HEDIS, Resolution Specialist, Financial Resolution Specialist and Coordinator HEDIS.Experienced in assisting the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight.Proficient in assisting Manager in training abstractor staff and participates in the medical record IRR.Collects medical records and reports from provider offices based on member needed services reports and gaps and loads data into the HEDIS application.Call providers to verify mailing address and phone number and patient demographics, Fax HEDIS information to that provider.Skills:HEDISMedical recordsMicrosoft officeSpreadsheetPowerPointProblem solvingCommunicationEmdeonInvisonSSIOMNIEPICAS400HeronEnrollment specialistA/P-A/R Specialist in accountingSalesforceQSHRIleadIsetEMRMedical RecordsCIOX< Change HealthcareEducation:Phyllis wheatley high school - Huston, TX 1971High School DiplomaProfessional Experience:UHC Atlanta, GA Jan 2017 to Nov 2022SOS / HEDIS RemoteRate, scrub census, email for missing information for AEs and sales teamEnter medical health plans and summaries for case loadAssists the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight.Assists Manager in training abstractor staff and participates in the medical record IRR.Identifies member service gaps based on data loaded in the MHI HEDIS application.Collects medical records and reports from provider offices based on member needed services reports and gaps and loads data into the HEDIS application.Sent out proposals/exhibits to Brokers and Sales TeamRan 2 applications to send rating/underwriting team for case also completion and preliminary proposalsfor medical insuranceRun FQT in Salesforce for Rating and UnderwritingKeep all information logged into WITTKeep Omega updatedCall providers to verify mailing address and phone number and patient demographicsFax HEDIS information to that providerReceive faxes from providers, managed over 100-20 per week providersMake corrections to any sensitive information in the system and request the correct patient informationFaxed lab test, measures, and eye test, child vaccines, diabetes, blood pressure, correct provider information, to the indexing teamParticipates in special projects and performs other duties as requiredWorked on QSHR, Iset, Ilead, EHR, EMR, EPIC, and requested medical records as needed.Optum 360 - Atlanta, GA Jan 2017 to May 2017Project Coordinator HEDIS RemoteCall providers to verify mailing address and phone numberFax HEDIS information to that providerAssists the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight.Assists Manager in training abstractor staff and participates in the medical record IRR.Identifies member service gaps based on data loaded in the MHI HEDIS application.Collects medical records and reports from provider offices based on member needed services reports and gaps and loads data into the HEDIS application.Receive faxes from providers, managed over 100 providersMake corrections to any sensitive informationFaxed lab test, measures, and eye test information to the indexing teamParticipates in special projects and performs other duties as required.ABLM Inc- Atlanta, GA Dec 2016 to Jan 2017Resolution Specialist RemoteResolves claim denials.Ensures that claims are paid correctly and appeals are completed for any short paid claims.Resubmits claims when necessary.Works closely with the billing specialists to ensure that all claims are billed properly and communicateswhen the payer requests any specific information regarding the claim.Participates in branch management, department and intradepartmental meetings and PerformanceImprovement activities as related to job description.Participates in special projects and performs other duties as required.Work the admin Denials verify why they denied the claimCall the patient to verify their insuranceUpdated the insurance information as needed, clinics and hospitalsAppling adjustmentsOptum 360 - Dunwoody, GA Aug 2016 to Nov 2016Financial Resolution Specialist RemoteResolves claim denials.Ensures that claims are paid correctly and appeals are completed for any short paid claims.Resubmits claims when necessary.Works closely with the billing specialists to ensure that all claims are billed properly and communicateswhen the payer requests any specific information regarding the claim.Participates in branch management, department and intradepartmental meetings and PerformanceImprovement activities as related to job description.Participates in special projects and performs other duties as required.Work the admin Denials verify why they denied the claimCall the patient to verify their insuranceUpdated the insurance information as needed, clinics and hospitalsAppling adjustmentsOptum 360 Atlanta, GA Feb 2016 to May 2016Project Coordinator HEDISCall providers to verify mailing address and phone numberFax HEDIS information to that providerReceive faxes from providers, managed over 75 providersMake corrections to any sensitive informationFaxed lab test, measures, and eye test information to the indexing teamParticipates in special projects and performs other duties as required |
