Category: HEALTHCARE

         HEALTHCARE EFFECTIVENESS AND INFORMATION SET COORDINATOR (HEDIS)       Summary     To obtain a position which utilizes and enhances my education and work experience with the Potential for career advancement. Recognized for long hours, commitment to customers, attention to detail and follow up. Work well as a team member or independently and under pressure. Demonstrates ability to meet the needs of patrons, dependable, hardworking and punctual. Excellent basic clerical and computer skill including knowledge of Microsoft Office. Excellent interpersonal, listening and communication; both written and spoken skills. Sound ability to keep sensitive information confidential. Sound organization skills, goal- oriented, proactive, and excellent at reporting.         Highlights          Proficient with Healthcare Effectiveness Data and Information Set (HEDIS)  Proficient with Georgia's Medical Management Information System (MMIS)   Proficient with Georgia Registry of Immunization Transactions and Services (GRITS)      Excellent communication skills  Advanced clerical knowledge  Filing and data archiving  Medical billing            Accomplishments     Provided award winning customer service to Consumer Cellular as well as AARP   Members with ordering easy to use cell phones       Experience      Healthcare Effectiveness and Information Set Coordinator (HEDIS)   04/2014   to   Current     Company Name   City  ,   State       Handle inbound/outbound member calls and assist them in obtaining service, appointment scheduling, arranging transportation, and initiating reminder calls, e-mails and/ or faxes.  Educate and inform members about current and past due clinical services which improves member health outcomes and increases Health Plan HEDIS rates.  Conduct HEDIS provider chart request calls to support medical record capture for HEDIS supplemental data review and abstraction.  Record and document all member and provider outreach activity using Microsoft Office Suite applications and web-based technology.  Review member plan eligibility using Georgia's Medical Management Information System (MMIS).   Review member claims data to determine need for services using the Health Plan Proprietary Information system or Georgia Registry of Immunization Transactions and Services (GRITS).  Identify and refer members to internal programs and services i.e. Case management and Disease Management,   Maintain strict confidentially and compliance with Health Insurance Portability and Accountability ACT during outreach activities.          Data Entry/File Clerk/ Receptionist/ Customer Service Rep   10/2013   to   01/2014     Company Name   City  ,   State       Entered information from lease into the system.  Pulled, Filed, and Organized Resident Lease's, in Numeric and Alphabetic order.  Worked the front window and signed in assisted walk-in clients.  Answered incoming calls, provided information about properties that are move-in ready, and contact leasing agents for information that assist with with more information the property, and transferred all other calls to the appropriate department.           Customer Service/ Pharmacy Technician   10/2012   to   08/2013     Company Name   City  ,   State       Provided customer service to patients who wanted or needed to save money on name brand prescription drugs.  Activated/Deactivated Rx Discount cards for qualifying and non-qualifying patients.  Assisted pharmacist and pharmacy technicians with proper steps on how to bill the Rx discount cards.  Verified card benefits, provided override codes when needed and reversed paid claims upon request.          Passport II Specialist   02/2012   to   09/2012     Company Name   City  ,   State       Provide General Information for customers who need assistance with obtaining a U.S. Passport.  Educate customers about personal account information and their minors Passport.           Customer Service/ Inbound Sales Rep   01/2011   to   12/2011     Company Name   City  ,   State       Provided award winning customer service to Consumer Cellular as well as AARP Members with ordering easy to use cell phones.  Took bill payments as well as made payment arrangements on account balances.          Customer Service/ Inbound Sales Rep   08/2010   to   01/2011     Company Name   City  ,   State       Assisted with ordering large appliances over the phone for customers.  Provided online assistance when needed and education about appliances.  Assisted with setting up appointments for cleaning , repair and delivery.          Customer Service/ Sales Rep   06/2008   to   12/2009     Company Name   City  ,   State       Provided award winning customer service to Sprint/Nextel and satisfy customers on every call.  Assisted customers with paying their bills as well as reading bills, sold phones and accessories, ported customers to Sprint/Nextel.  Handled account modifications and all account needs.  Assisted with technical support for the Peek device activated and deactivated services when needed or upon request.          Debt Collector   02/2008   to   05/2008     Company Name   City  ,   State       Assisted with every day transactions as instructed.  Attended Owens Community College after work hours.          File Clerk and Backup Receptionist   08/2007   to   10/2007     Company Name   City  ,   State       Alpha and Numerical Medical Record Filing for the Claims Department.          Sales Associate   05/2006   to   12/2006     Company Name   City  ,   State      Performed all duties as instructed.          Education      H.S. Diploma     2007       Humanities and Science Institute (ICI)   City  ,   State               Skills     Customer service, delivery, faxes, Filing, Insurance, Microsoft Office Suite, Management Information System, reading, scheduling, technical support, technician, phones. transportation