Mar 2018 – Oct 2022 · 4 yrs 7 mos · Cincinnati, OH

• Establish positive, long-term, consultative relationships with physicians, medical groups, and IPA’s. Responsible for program implementation and provider performance management by tracking designated provider metrics, inclusive minimally of 4STAR gap closure and coding accuracy. Working directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion. Develope comprehensive, provider specific plans to increase their HEDIS performance, facilitate risk adjustment gap closure and improve their outcomes.

Nov 2016 – Mar 2018 · 1 yr 4 mos · Cincinnati, OH

• Analyzed, reviewed, conducted and managed outcomes of various studies.
• Reviewed and analyzed high dollar claims; gathered data and trends of claim submissions denied appropriately or incorrectly.
• Composed outlines of findings and presented them to colleagues.

Dec 2011 – Nov 2016 · 4 yrs 11 mos · Oklahoma, Kansas, Missouri (Virtual)

• Provider Education/ Virtual Facilitator/ Medicare Risk Adjustment:
• Partnered with senior leadership on strategic initiatives.
• Managed multiple projects and met deadlines.
• Created and completed project charter, vision and scope, and project plan.
• Facilitated and captured requirements.
• Created and maintained action, issue, decision and assumption, and risk and mitigation logs.
• Provided status updates to stakeholders, team members and other interested parties.
• Established change control guidelines, process and escalation path for a project.
• Coordinated the development and implementation of communication and training plans.

Jun 2008 – Dec 2011 · 3 yrs 6 mos · Milford, OH

• >Reviewed medical record information to identify all appropriate coding categories
• >Complete appropriate paperwork /system entry regarding claim/encounter information
• >Provided support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards
• >Monitor Coding changes to ensure that most current information is available