Category: HEALTHCARE

         HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET COORDINATOR (HEDIS)       Career Focus     Committed and motivated Administrative Assistant with exceptional customer service and decision making skills. Strong work ethic, professional demeanor and great initiative.    Energetic, results-oriented team-player eager to bring strong administrative skills to a growing company in need of top-level support.    Responsible Office Manager versed in mediating employee conflict and running efficient daily business operations.   Effective Organization and Communication Skills / Master New Concepts Quickly / Initiate Document Control and Processing Information / High Level Customer Service and Detail Oriented / Report Composing and Document Presentation / Thorough Investigation and Monitoring / Patrol and Crowd Control Access       Core Qualifications          Microsoft Office Suite expert  People-oriented  Organized  Exceptional communicator      Deadline-oriented  Schedule management  Report analysis  Medical terminology            Experience      Healthcare Effectiveness Data and Information Set Coordinator (HEDIS)   08/2013   to   Current     Company Name   City  ,   State       Healthcare Effectiveness Data and Information Set Coordinator (HEDIS). Educate and inform members about past due clinical services that improve member health outcomes and increase Health Plan HEDIS rates. Make outbound calls to members; providing assistance with obtaining services by assisting with appointment scheduling, arranging transportation, and conducting reminder calls and/or emails. Conduct HEDIS provider chart request calls and faxes 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 Health 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. Identify and refer members to internal programs and services like Case Management and Disease Management. Maintain strict confidentially and ensure compliance with Health Insurance Portability and Accountability ACT (HIPAA) during all outreach activities.   Managed incoming and outgoing calls for busy medical office.   Successfully established effective systems for record retention by creating database for daily correspondence tracking.  Scheduled and confirmed appointments for entire management team.           Loss Prevention/Security Officer   12/2011   to   02/2013     Company Name   City  ,   State       Partnered with local store management to meet strategic loss prevention objectives.  Executed internal and external surveillances using state-of-the-art detection and investigation systems.  Prepared data for property and damage reports, recording malfunctioning of facility equipment, and attended weekly staff meetings to discuss the damage reports.  Detected and apprehend shoplifters, processing and recovering of merchandise, prepared case reports on theft details and maintained an effective relationship with local law enforcement agencies.   Represented Macy's in court proceeding related to apprehensions and ensured high execution of company security measures designed to control store and shrink.  Developed staff training for designated stores.          Security Officer   07/2010   to   10/2011     Company Name   City  ,   State       Patrolled designated areas watching for unusual conditions that create security concerns or safety hazards.  Monitored and authorized entrance and departure of employees, visitors, and other persons to guard against theft and maintain premise security.    Investigated, prepared reports, and maintained written logs on accidents, incidents, and suspicious activities.   Answered telephone calls, taking messages, and answered questions providing information during business and non-business hours.  Observed departing personnel to protect against theft of company property and ensured authorized removal of property was conducted within appropriate client requirements.           Account Receivables/Administrative Assistant   07/2007   to   10/2008     Company Name   City  ,   State       Investigated discrepancies, issued debit memos, reviewed aging balance reports to identify past due accounts, collection calls, and month-end close activities.   Accounts receivable reconciliations; utilized collection screens to quickly analyze account and met department goals by reducing delinquency and controlling losses at a considerably high margin.  Fielded all calls on 12- line multi phone system, responded to email and fax inquiries, managed mail and client trafficfor the body shop, upgraded office filing system for improved efficiency in locating customer files, handled all official company correspondence, analyzed and reconciled all final billing statements to ensure the correct amount of funds were collected and applied before file closeout.  Displayed excellent interpersonal skills and phone manner during interaction with insurance agents, co-workers, and the public.  Calculated time cards for department employees in preparation of submitting payroll, collected and applied all funds received from various insurance companies such as State Farm, USAA, Allstate and Geico to the appropriate client auto claim accounts in a timely manner.          Detention Specialist   07/2002   to   10/2005     Company Name   City  ,   State       Supervised Central Control and Tower Controls in the Detention Center.  Completed intake and release of detainees.  Interacted with defendants, attorneys and the general public, providing them imperative information.  Processed accounting functions of paperwork in the Bonding Department.  Performed other duties as assigned.  Answered incoming/outgoing calls on the  switchboard regarding inmates' custody issues and guided them by resolving their predicaments.          Probation Case Specialist   07/2000   to   12/2001     Company Name   City  ,   State       Retrieved criminal records to update history with new charges and probation status on various specialty systems.  Maintained statistical data concerning case processing activities for three probation officers and performed various financial transactions.  Performed other duties as assigned to include handing all incoming/outgoing calls from magistrate court judges, attorneys, probation officers and the general public.          Experience      Customer Service     Handled customers effectively by identifying needs, quickly gaining trust, approaching complex situations and resolving problems to maximize efficiency.  Handled customers effectively by identifying needs, quickly gaining trust, approaching complex situations and resolving problems to maximize efficiency.    Data Reporting     Compiled statistical data, such as patient admissions, discharges, deaths, births and types of treatment given.    Document Organization      Developed and created effective filing system to accelerate paperwork processing.     Medical Records     Reviewed medical records for completeness, assembled records into standard order and filed records in designated areas according to alphabetic and numeric filing system.    Multitasking     Demonstrated proficiencies in telephone, e-mail, fax and front-desk reception within high-volume environment.         Education      Certified Medical Office Assistant  :   Medical Administration   2009       Kennesaw State Continuing Education   City  ,   State  ,   USA      •Medical Office Receptionist/Support Specialist, Patient Scheduling, Medical Records/Documents, CMS 1500 Medical Billing, Medical Terminology/Basic Anatomy and Physiology, Specialized Billing/Reimbursement, Business Skill and Management, 80 hour Medical Externship at WellStar Medical Center, Certified CPR w/AED         Skills     Accounts receivable, Administrative Assistant, Basic Billing, CMS, excellent interpersonal skills, CPR, email, faxes, filing, law enforcement, loss prevention, Medical Billing, Medical Terminology, Microsoft Office Suite, Management Information System, payroll, safety, Scheduling staff training, switchboard