Healthcare – Remote/Virtual – Telecommute Managed the HEDIS and Risk Adjustment chase collection and monitored rate improvement of assigned reporting populations tracking clinical documentation and gaps in medical care.Complete abstraction, Overreading and MRRV of medical records for Quality Assurance during HEDIS, GRPRO and PSDC, contacting providers and utilizing claims databases as necessary.Analyze, interpret and present quality metrics and healthcare data by created detailed reports and identifying areas to strategize for improvement in project rates.Collaborate with providers, vendors and internal staff regarding the management of onsite reviews and collection of electronic medical records from various systems.Participate in End-to-End testing and development input for Ratelift prior to team usage and request process improvements for better outcomes.Assist with the development of team data collection strategies and processes during end of season evaluations.Educate providers and staff regarding requirements of HEDIS when requesting required

Supervised a team of 16 contracted Clinical Quality Specialists in office for 2014 HEDIS project for United Healthcare.Learned onboarding process and implemented for each contractor and insured proper accesses were given. Learned Technical Specifications for 8 measures and trained contractors in proper collection and retrieval methods.Learned United Healthcare’s claims database usage and trained contractors in proper use of databases. Provided quality assurance reviews of contractors’ work assignments and monitored progress. Requested medical records by phone and fax from providers offices.  Accessed claims databases, reviewed claims and abstracted needed information.  Maintained extensive Excel Spreadsheets to continually have readily available important information regarding projects.Troubleshooted questions and concerns from providers and provided detailed responses.Served as liaison between United Healthcare management team and my team of contractors