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Click here or scroll down to respond to this candidateCandidate's Name
Mahwah, NJ Street Address
PHONE NUMBER AVAILABLE - EMAIL AVAILABLEProfessional SummaryCandidate's Name Provider Engagement Coordinator Dedicated Medical professional with over 15 years of field experience. Skilled in working under pressure and adapting to new situations and challenges to enhance the corporate brand. I am seeking a position where I can utilize my skills and abilities for the development of the organization. Perceptive Quality Coordinator with 10 months of experience reviewing and optimizing systems and processes. Observes and collaborate with the main workforce to understand and streamline standard operating procedures. Innovative in increasing productivity and eliminating waste.SkillsMedical Records ReviewTest Results InterpretationMedication ReviewTesting DocumentationContract ComplianceDirect Patient CareQuality Improvement ActivitiesPatient Health Information AccessConfidential Records ManagementQuality Patient CareWork History03/2022 to CurrentQuality CoordinatorMetro Plus Health Plan New York, NYServe as a liaison between MetroPlus Health Plan, Metropolitan Hospital Center, and seven different community sitesEducate providers and office staff on provider report cards and incentive opportunities, proper coding formeasure compliance and completion of file feed, and proper documentation for hybrid measures, i.e., COA, CBP, EED, WCV, PPC, COL, CCS, etc.Review patient charts and medical records and make recommendations regarding medications, treatments, medical procedures, and other treatment plans.Conduct ongoing activities which monitor established quality of care standards in the participating provider network and for care managersCollect, analyze and prepare clinical record information for projects related to assessing the efficiency, effectiveness, and quality of the delivery of managed care servicesPresent findings at provider and customer meetings as neededAssist in the planning and implementation of activities to improve the delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managersReviewing required data analysis and research within the company's data systemsMeeting with clients to gather information about their needs and expectations regarding project outcomesShare and review monthly member Gaps-In-Care reports with providers & medical management staffMonitor provider-specific HEDIS report cards. Identify areas of concern and address them with office management and hospital contact work with provider office/facility to identify members that are already compliant, send file feed to Data analysisOutreach to non-compliant members to make appointments for the required servicesEnsure all priority measures reach the next level benchmark, i.e., 50th to 90th or QM department goal, if assignedImplement aggressive community outreach programs targeting members with crucial Gaps-In-Care (Non-Compliant members)Access and Availability education with providers on proper protocol for a timeframe on seeing patients are done on a regular basisAssist Managed Care Department with projects that increase HEDIS/QARR performancesPerforms other duties as assigned07/2016 to 02/2022Provider Engagement CoordinatorADVANTASURE / TESSELLATEReviews and analyzes patient medical records to assess and procure accurate and complete documentation of patient diagnoses and proceduresNotifies attending physician and house staff officers or other disciplines promptly of documentation requiring clarificationSubmit daily visit documentation and follow-up information timely and as requiredDialogue and guide practice staff/physicians in response to feedback from company physiciansOrganizes the information for each patient seen by a medical establishment and reviewing medical records, ensuring medical codes have been inputted correctly, and documenting the specifics necessary to provide a full analysis of a patient's healthBuilt and maintained relationships with managed care.Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.Carried out day-day-day duties accurately and efficiently.Demonstrated respect, friendliness, and willingness to help wherever needed.Maintained energy and enthusiasm in a fast-paced environment.Worked flexible hours; night, weekend, and holiday shifts.Ensures all clinical documents are in compliance with federal laws in terms of composition and secure storage.Created and maintained physical and electronic personnel records.Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification purposes.Communicated with physicians, nurses, and other caregivers to explain the importance of accurate and clear documentation.Maintained strong knowledge of medical terminology, diseases and conditions, and procedures.Carefully reviewed patient files for clarity on diseases, diagnoses, and procedures to determine the quality of care.Maintained accuracy, completeness, and security for medical records and health information.Input data into computer programs and filing systemsCommunicated effectively with staff and insurance companies by email and telephone.Maintained database for storage and retrieval of medical records.Followed exact procedures for handling transfers and other releases of medical records.Compiled electronic patient records covering conditions, treatments, and diagnoses.Processed patient admission and discharge documentation.Handled high-volume data entry of demographics, disease etiology, and the extent, and associated procedures or treatments.Identified new methods to optimize medical records management.Posted billings to medical insurance providers.Supported smooth admission and discharge processes by handling associated documents.Compiled, abstracted, and coded patient data using classification manuals and standard systems.Used classification manuals to gain additional knowledge of disease and diagnosis processes.Researched and compiled statistical data to support cost control and care improvement initiatives.Utilized EPIC/QUADRAMED to manage and confirm patient data, such as insurance, demographic and medical history information.Performs other duties as assigned01/2015 to 01/2016Medical Assistant,SIRM Purchase, NYPrep all exam rooms appropriate to the patient appointment and testing needsDocumented vital signs and health history for patients in clinic and hospital environments.Called and faxed pharmacies to submit prescriptions and refills.Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.Assisted with routine checks and diagnostic testing by collecting and processing specimens.Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.Taught patients about medications, procedures, and care plan instructions.Completed clinical procedures and gathered patient data for interpretation by physicians.Collaborated with medical and administrative personnel to maintain a patient-focused, engaging and compassionate environment.Obtained pre- and post-treatment vital signs and weight.Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.Tested and recorded blood glucose levels.Prepared initial patient charts for admission.Verified appropriate lab couriers picked up collected lab specimens.Obtained all prescribed laboratory testing.Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.Ordered and prepared reagents and supplies.Arranged surgeries with the surgical center, confirming times with patients and preparing admission and consent forms.Compiled necessary documents for surgical billing packages.Ambulated, turned, and positioned patients.After each patient exam/appointment, use disinfectant to prepare the exam areasProvide appropriate prescriptions and patient prep information for pre-op patients scan into patient EMR all signed consents, office appointment forms, laboratory and pathology reportsSanitized, restocked, and organized exam rooms and medical equipment.Obtained the client's medical history, medication information, symptoms, and allergies.Directed patients to exam rooms, fielded questions, and prepared for physician examinations.Collected and documented patient medical information such as blood pressure and weight.Performed clerical duties, such as word processing, data entry, answering phones, and filing.01/2007 to 01/2016Endoscopy TechnicianDigestive Disease of Rockland Pomona, NYInterview patients to obtain medical informationTake their vital signs, weight, and height and set them up while waiting for PhysicianAssist providers with all procedures and serves as a resource to the use and maintenance of equipmentHelp physicians examine and treat patients, handing them instruments and materials or performing such tasks as polypectomy, cauterizing, and BravoPerform routine laboratory tests and sample analysesResponsible for Cross/checking for all patients Pathology submitted to the labs.Efficiently set up and tore down procedure rooms in preparation for upcoming procedures.Collect and prepare specimens for cytology, microbiology, and pathology.Clean and sterilize endoscopes, forceps, snares, and other tools and equipment following established infection control procedures.01/2008 to 01/2013Medical assistant/Laboratory TechnicianGYN OF ROCKLAND New City, NYPull and record laboratory results for patients and Maintain accession logsAssist providers with exams and minor surgeries/procedures including pap smears and colposcopiesProvide clerical support to both the providers and staffCounsel patients with their laboratory resultsCollected blood tissue or other specimens as requestedSet and oversaw quality assurance guidelines for laboratory work.Executed corrective actions when test controls were outside specified limits.Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.Carried out day-day-day duties accurately and efficiently.Performed duties in accordance with applicable standards, policies, and regulatory guidelines to promote a safe working environment.Proved successful working within tight deadlines and a fast-paced atmosphere.Used critical thinking to break down problems, evaluate solutions and make decisions.Exceeded goals through effective task prioritization and great work ethic.EducationExpected in 03/2024Bachelor of Science: Public HealthSouthern New Hampshire University - Hooksett, NHCertificationsMedical Assistant CertificateUltrasound Tech |
