Category: HEALTHCARE

         SURGICAL CLINICAL REVIEWER       Summary      A self-motivated and organized professional with over 20 years' experience providing thorough and skillful support.  More than 10 years' management experience in organizational leadership and relationship building with clients and team members. Administrative experience in diverse business settings. Extensive international experience, with a deep understanding of diverse cultural and business practices, professional international liaison.  Excellent writing skills, and the ability to find innovative solutions. A patient listener who fully focuses on speakers and understands a variety of accents.  A flexible professional who enjoys learning new skills and quickly adapts to organizational changes.  An energetic team leader, able to communicate effectively with people of all ages and backgrounds, to work collaboratively to resolve problems, and to motivate team members to achieve personal and organizational objectives. Self-starter with strong communication skills; work well independently or on a team.  Skilled clinical researcher and administrator; hold a BS Degree in Health Information Management and currently enrolled in an MBA Degree.        Highlights        Management skills: administered, coordinated, delegated, evaluated, prioritized, performed trouble shooting, HR duties, Manage PTO, payroll, interview, hire and train new personnel, team goals Research skills: collected, extracted, organized, interpreted, summarized, audited Communication skills: corresponded, professional telephone etiquette, excellent customer service, Bilingual interpreted translated English/Spanish Detail skills: catalogues, multi-tasked, set goals, skilled typist, working knowledge of computer soft wares Creative skills: customized, integrated, established, marketing Clerical skills: compiled, monitored, generated, implemented              Experience     01/2011   to   01/2014     Surgical Clinical Reviewer    Company Name        Collected and submitted reliable data to the ACS NSQIP for surgical patients, provided morbidity and mortality postop reporting, generated lists of cases to be abstracted, and completed abstraction of applicable cases by entering data into the appropriate database (NSQIP). Participated in inter-rater reliability reviews to ensure accuracy of abstraction, validation and audits, followed up on appeals as necessary, and participate in conference calls and webinars.       01/2008   to   01/2010     Field Reviewer/Auditor    Company Name        Provided support for the 2009 and 2010 HEDIS project including Physician Grading, (payment integrity audit), Reporting, Medical Record Abstraction, Quality Improvement, and data analysis, provided feedback reporting to HEDIS, NCQA and other governing and regulatory agencies.       01/2004   to   01/2008     Healthcare Business Consultant    Company Name        Provided quality assurance reviews specializing in outpatient centers along with business development strategies. Reviewed charts to ensure correct coding for the services billed. Conducted mock surveys of facilities, and kept up to date with policies and procedures. Developed training schedules and job descriptions for staff and conducted performance evaluations. Handled payroll, billing issues, and physician contract credentialing. Hired and terminated staff as necessary. Provided findings to both Medicare and facilities for reconciliation, as well as, resolved claim issues with physician offices to collect outstanding monies.       01/2002   to   01/2004     Health Information Manager    Company Name        Oversaw all Health Information Management work flow in department, including performance of employees, training, and orientation of new staff, in-service of current employees, payroll submission, and medical record completion per JCAHO guide. Participated in JCAHO, HEDIS, ACHA and Tumor Registry reviews committee. Responsible for Utilization and Records Committees, Medical Records Abstract, in house clinical pertinence, closed chart review, 3M Encoder knowledge, and managed staffing levels in accordance to departmental needs.        Education     2015       Paralegal    Blackstone Institute          Blackstone Institute - Paralegal course currently enrolled 2015, expected completion June 2015       2015     MBA  :   Public    Northcentral University          Northcentral University - MBA Public currently enrolled 2014 - 2015            Certificate of Completion  :   Surgical Clinical Reviewer    ACS NSQIP Certificate of Completion Surgical Clinical Reviewer October 2012            BS  :   Health Information Management    Florida International University          Florida International University - BS Health Information Management - Dec 1999            AA  :   Psychology    Miami Dade Community College          Miami Dade Community College - AA Psychology - May 1999        Certifications    ACS NSQIP Certificate of Completion Surgical Clinical Reviewer      Languages    customer service, Bilingual interpreted translated English/Spanish      Presentations    Collected and submitted reliable data to the ACS NSQIP for surgical patients, provided morbidity and mortality postop reporting, generated lists of cases to be abstracted, and completed abstraction of applicable cases by entering data into the appropriate database (NSQIP). Participated in inter-rater reliability reviews to ensure accuracy of abstraction, validation and audits, followed up on appeals as necessary, and participate in conference calls and webinars      Skills    Payroll, Training, Hedis, Audits, Cases, Database, Billing, Business Consultant, Business Development, Coding, Healthcare, Medicare, Outpatient, Quality Assurance, Reconciliation, Audit, Data Analysis, Marketing Analysis, Encoder, Medical Records, Staffing, Work Flow, Mba, Clerical, Clients, Customer Service, Energetic, Etiquette, Excellent Writing, Excellent Writing Skills, Hr, Liaison, Marketing, Pto, Receptionist, Relationship Building, Retail Sales, Self Motivated, Self-starter, Solutions, Strong Communication Skills, Telephone, Translated, Writing Skills, Paralegal