Dec 2023 – Oct 2024 · 10 mos

• As a seasoned professional, serves as the go-to expert on NCQA HEDIS, CMS STARS, and Patient Experience within the organization. Key responsibilities and achievements include:
• Negotiating and Monitoring Contracts: Skillfully negotiates and closely monitors health plan contracts, ensuring compliance and minimizing risks associated with Quality Gate penalties. With over $800 million at stake, attention to detail is paramount. Consistently achieved 4.0+ to avoid 99% of all penalties. Saving the organization $792M in potential lost shared savings.
• Strategic Leadership: Leads, develops, and translates strategies for the organization’s HEDIS/CMS STARS/Patient Experience initiatives. Oversees approximately750,000 MA members in Value-Based arrangements across the country. By tailoring strategies to the unique needs of each group, Value-Based Contracts successfully elevated Star levels from an average of 3.5-4.0 to 4.5 within 3 years of joining the platform. Notably, improvements in data completeness and medication adherence played a significant role.
• Data-Driven Insights: Identifies trends, devises effective strategies, and implements processes to enhance member information collection. Efforts contribute to improved HEDIS, STAR, and Patient Experience rates. Deep analysis of data discovered gaps in supplemental data, which lead to a whole Star improvement with those contracts.
• Quality Reporting and Analysis: Meticulously reports and analyzes data, informing the development of impactful plans and programs. Enhanced efficiency and scalability by collaborating with a third-party vendor on medication adherence efforts, resulting in an improvement from a 3-star rating to a 5-star rating across all medication measures within 2 years.
• Collaboration and Compliance: Collaborates closely with Health Plans on data submission, leveraging deep understanding of data’s impact on HEDIS rates. Partners with executive leadership to deploy successful compliance strategies.

Jan 2017 – Dec 2023 · 6 yrs 11 mos

Jan 2017 – Oct 2024 · 7 yrs 9 mos · Corona, CA

• Responsible for leading, developing, translating, auditing, submitting, directing and executing the Healthcare Effectiveness Data and Information Set (HEDIS) line of business for the organization. Act as the Subject Matter Expert and support all administrative functions surrounding HEDIS operations. Gather, prepare and generate specific data sets and summaries including claims, encounters, utilization and other metrics measuring performance. Identify trends, develop strategies and implement processes to increase collection of member compliant information resulting in overall improved HEDIS rates. Report and analyze member care quality for the development of plans and programs. Collaborate with executive leadership to deploy strategies for compliance, successful data collecting and reporting.

Aug 2012 – Jan 2017 · 4 yrs 5 mos

Mar 2008 – Aug 2012 · 4 yrs 5 mos

• Recruited to provide project coordination between stakeholders and the IT and Facility departments for key companywide process improvements. Also assist in other company projects on an ad-hoc basis. Gather and document requirements clearly and consistently based on a well-defined project scope using expert elicitation techniques. Create and publish all company website content using various web technologies. Contain purchasing costs for all IT hardware and software purchases/maintenance by negotiating rates with vendors.

Oct 2004 – Mar 2008 · 3 yrs 5 mos

• Promoted from Administrative Assistant position to IT Project Coordinator to provide the IT department with project support in all projects and also web administration. Obtained quotes and created PO’s for all IT purchase requests.

Oct 2004 – Mar 2008 · 3 yrs 5 mos

• Promoted from Administrative Assistant position to IT Project Coordinator to provide the IT department with project support in all projects and also web administration. Obtained quotes and created PO’s for all IT purchase requests.