Dr. Rionda Ridley, Dha, Mha Email & Phone Number

Louisville, Ky, Us

Serves as a subject matter expert in HEDIS leading and implementing quality programs intended to provide lifts to critical at-risk measures across Medicare, Medicaid, MMP, and Marketplace for CA, MA, NE, NM, and OH Health Plans. Develops business cases for each Health Plan summarizing the potential impact Enterprise quality programs offer. Collaborates with cross-functional teams to craft diverse messaging for various member-facing materials delivered via multi-modal communication channels. Works alongside with Enterprise partners in Accreditation for collaborating on quality improvement initiatives. Directs the Health Plan through the implementation process for quality/vendor programs most beneficial to achieve desired scores in Star, Health Plan Rating, and Quality Rating System.• Piloted a Medicare Hypertension program in OH which returned a 15% lift to their overall CBP score.• Piloted a HomeCare Incentive pilot in MA paying out over $25,000 to providers for closing gaps in care during the month of December.• Incorporated coordinating care management into our At Home Screening Kit Program for members testing positive or received out-of-control measurements.

Sellersburg, Indiana, United States

Facilitates student learning by delivering assigned classes in accordance with College policy and course objectives. Responsible for selecting and compiling tests, quizzes, assignments, in-class activities, and online discussion exercises that permit measurement of performance relative to standardized learning objectives.

Oversee all aspects of HEDIS audit and administered project setup and staff training to ensure successful HEDIS season. Compile all regulatory reports on quality improvement according to NCQA and state requirements. Closely collaborate with data analyst and strategize plans to build audit tool to generate medical record requests, pass/fail letters and track overall project. Engage in improvement workgroups and develop measure specific interventions to increase compliance rates. Direct task team to devise clinic day program for Anthem members to deliver information on chronic illnesses and its preventative methods, and receive at-home testing kits, and on-site prevention tests when necessary. Actively train and mentor care coordinators on best practices and increase overall scores and participation in the P4Q incentive program. Ensured appropriate process approach by creating supplementary data submission companion guide for provider groups. Acted as point of contact between the provider group and IT for EMR integration and flat file transfers and optimized MRDB procedure for assessing additional data from provider groups• Actively engaged in eight quality improvement workgroups and developed interventions that significantly improved compliance rates.• Efficiently redesigned supplementary data procedure that enabled provider organizations to easily send supplemental data.• Acquired the largest IPA group for company that has 25% of membership connected to submit supplemental data digitally.

Louisville, Kentucky Area

Oversaw all state-wide efforts while serving as a subject expert on Medicare. Directed the development and execution of the Wellness First Program, which aimed to concentrate on Risk Adjustment, HEDIS/Stars, and CAHPS at the same time. Piloted team to the first-ever 4 Star Medicare performance in the market. Supervised the HEDIS Medical Record Review project in entirety. Analyzed data linked to quality improvement in both qualitative and quantitative way, submitted efforts for improvement to the Quality Improvement Committee for approval. Developed measure-specific, in-depth reports to aid in decision-making and better knowledge of market activity. Monitored and reported on all NCQA-related accreditation efforts for the Marketplace and Medicaid lines of business. • Designed provider engagement program to mitigate the negative effects of Medicare expansion related to CAHPS and STAR scores in 26 new Medicare LOB counties and used statistical forecasting and modelling to show the program's effectiveness and potential future applications.• Oversaw all quality-related components of Medicare, Medicaid, and Marketplace with team of seven direct reports, including managers and supervisors.• CMS Star score increased from 3.39 in 2018, 3.53 in 2019, and 3.61 in 2020 in setting of rapid growth that included the extension to 26 counties.• Boosted Health Plan Ranking from 3.68 in 2018 to 3.72 in 2019.• Achieved market’s first-ever four-star Medicare performance by efficiently leading the team.

Louisville, Kentucky

Developed and nurtured strong relationships with healthcare providers while educating and supporting provider facilities. Supervised and managed patient care delivery and ensured highest levels of standards are provided to healthcare professionals in accordance with medical plans. Onboarded new QPAs to acclimate to the new role. Supervised pharmaceutical management and updated physicians on the type and cost of patient prescriptions and established strong provider communication channels to accurately record patient chronic diseases. Suggested solutions for provider complaints and investigated disputes to tackle underlying problem and improved provider relationships with clear and straightforward communication focused on best outcomes. Asserted for QPAs to ensure necessary resources and tools were provided for better outcomes. Implemented chart audits and educated groups on order improvements to fulfil compliance criteria.• Improved provider performance by evaluating process accomplishments and coaching in areas for growth.• Significantly improved quality metrics for top 10 non-compliant suppliers.

Louisville, Ky

Effectively communicated patient progresses and levels of care to physicians and acted as a mediator between hospital and doctors. Supervised payment adjudications and overall payment claims while ensuring all processes were addressed and completed by collecting claims data and partnering with providers. Accessed and evaluated relevant healthcare activities and maintained accurate reports. Performed extensive audits and reported outcomes to practices and advised out-come based improvements. Analyzed and identified care gaps and high-risk patients to strategize recommendations on QI measure. Assisted in the establishment of QI strategies and procedures by providing technical help. Actively participate in practices to ensure MCO’s incentive quality care programs are well optimized and administered implementation of practices to run through PCMH certification application process. Partnered with ACO-participating providers to enhance care management for Medicare beneficiaries while planning and leading semi-annual quality collaborative meetings.• Enhanced 57 APCP/TPN IPA practices’ care coordination programs by assisting the development and implementation of operational, procedural, and reporting changes.

Louisville Ky

Developed trust of employees and residents by directing and managing every aspect of residential living. Implemented to create new operational procedures to renovate and revive assisted living community. Incorporate innovative changes to improve resident happiness and experience and o oversaw the daily operations of the Personal Care Neighborhood. Promoted people' personal and professional development while guiding in specific tasks. Methodically evaluated staff performance to coach and cultivate individual strengths and searched for methods to assign challenging work to foster professional development. Integrated evidence-based procedures into day-to-day operations to ensure superior patient treatment. • Reduced overall expenses by strategically restructuring time schedules and provided staff coverage during peak times of the day.• Significantly reduced staff turnover by administering operations precisely.

Doctor Of Healthcare Administration, Health/Health Care Administration/Management, 3.8

Doctor Of Healthcare Administration, Healthcare Administration

Master Healthcare Administration, Healthcare Management

Licensed Practical Nurse

Bs Business Management, Management