Experience

Gold Coast Health Plan

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Quality Improvement Specialist

  • Jul 2018 - Present

  • Managed department Member Incentive Program for Postpartum and Well-Child visit. This included the collection, compliance check, processing, and data entry using multiple database systems. • Responsible for maintaining and assembling data used to generate reports by accurately abstracting data according to the specific criteria of project.• Assisted with project management on annual Electronic Data Validation audit. Collected, processed, and submitted high-quality encounter data to Health Services Advisory group (HSAG) for the monitoring and assessment of the plans quality.• Collaborated with clinical systems to retrieve medical record for HEDIS reporting.• Assisted with preparation of HEDIS reports for dissemination to providers and company.• Ensured that data met the regulatory requirements and was submitted timely.• Screened forms submitted by plan members for accuracy and completeness.• Aided with the credentialing and re-credentialing of medical professionals by conducting primary source verification. Utilized a variety of government websites to determine the accuracy of the qualifications of a health care practitioner. • Performed debase queries to manage expired and current items.



County of Ventura

• Government Administration
• 700 & Above Employee

• Technical Specialist IV

  • Oct 2017 - Jul 2018

  • Regularly maintained and updated program database and various spreadsheets, each cor-responding to different programs within the public health department. • Generated various reports from database to be exported into excel sheets for data mining in order to analyze effectiveness of program. Presented findings and recommendations to program director and staff.• Collaborated with department staff to gather program statistics to ensure program goals were met on a monthly basis and reported findings to stakeholders. • Assisted fiscal department with collection of required data for billing by creating, updat-ing, and managing claim spreadsheet.

• Community Services Coordinator

  • Dec 2012 - Oct 2017

  • Generated daily, weekly, and monthly reports to analyze and evaluate clinic de-mographics. • Worked with Lead Program to create a county geographic report on lead cases in order to evaluate community needs and distribution of resources. • Filtered and migrated data from lead state report to check for inaccuracies and verify county statistics. • Worked with database manager to consolidate duplicate client profiles for entire behav-ioral health agency. • Documented findings of focus groups and community interactions to maintain accounta-bility for stakeholders and grantors.

• Records Technician/Recruiter & Trainer

  • Jan 2012 - Dec 2012

  • Organized, stored, and maintained volunteer and voter demographics in software data-base. • Coordinated, scheduled, and conducted training sessions for election workers through Ventura County.• Proofread official state election ballot for dissemination on Election Day. Reviewed and examined documents and records for completeness and compliance with multiple elec-toral guidelines.