SUMMARY: I work in a cooperative fashion that encourages teamwork and utilize my interpersonal skills to foster resolution of issues. I consider myself meticulous and excellent at juggling multiple tasks and working under pressure. I am an experienced manager with excellent client and project management skills. I am action-oriented and possess a strong ability to communicate effectively with all type of audiences. I welcome a challenge, enjoy people and love diversity. * Collaborated with internal/external entitles in the development of quality initiatives revision of policies procedures studies and projects that impact or improve member care including preventive care and interventions NCQA accreditation Human Services Department compliance HEDIS Medicare 5-Star Program and State performance measure adherence. Served on collaborative external committees and work groups to implement and improve processes. * Participated in the plan-wide preparation for NCQA accreditation survey through structured readiness assessment team meetings. * Prepared documents for various audits and surveys for State and NCQA compliance Medicare Medicaid and Marketplace lines of business. Coordinated prepared and submitted plan documentation for the annual HEDIS Roadmap maintained and resolved issues for final submission to Attest audit team. * Supervised the HEDIS and Risk Adjustment staff in the collection of medical records and other essential project activities to successfully meet the needs identified to accomplish goals. * Collaborated with staff and leadership to develop and/or improve processes to effectively and efficiently meet with State and national guidelines. * Educated providers about documentation standards preventive health and best practice guidelines to ensure that our members receive or continue to receive high quality care. * Collaborated with data analysis to identify significant and problematic issues and concerns devised improvement plans and measured impact of actions. * Assisted with data analysis to identify significant and problematic issues and concerns devised improvement plans and measured impact of actions.

Highlights:

• Managed Care
• Audit
• Licensing
• Billing
• Documentation
• Data Analysis
• Data Management
• Diversity
• Leadership
• management