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Yyyyyy x. yyyyyy

Xxxxxx, XXXXXX xxxxxx (xxx-xxx-xxxx



Practice Management Managed Healthcare ACOs Program Development / Management

Quality / HEDIS Audits Records Review / Appeals PQRS Reporting Regulatory Compliance

Clinical Nursing Transitional Care Team Building RN Training / Development / Instruction KPIs

Profit / Loss Multimillion-Dollar Budget Control Strategic Analysis / Planning Trends Tracking

Medicare / Medicaid MACRA Private Payer Insurance Value-Based Reimbursement Medical Marketing


Highly Accomplished, Multi-Credentialed Healthcare Leader who offers judicious decision-making to align with a multi-site facility s strategic vision, value, and goals and continually promote patient-, safety-, quality-, and profit-focused initiatives. Top Performer who contributes solutions-centric critical thinking for insightful, change-oriented patient care results, and who leverages nursing and business management experience to drive success in a competitive healthcare market. Visionary Professional who rises above challenges to achieve winning outcomes, including quickly adapting to evolving scenarios. Excellent Communicator who develops synergistic relationships with cross-geographical healthcare teams, third parties, patients, families, and the community, and who leads peers by example and with ethics and integrity to maximize an employer s success.


Career Highlights Include:

  Actively managing multimillion-dollar budgets.

  Seamlessly launching go live marketing campaigns.

  Strategically creating multimillion-dollar marketing plans.

  Continually spearheading product line quality improvements.

  Researching Medicare / Medicaid, ACOs, and private payer trends.

  Co-launching two new service lines in accordance with Medicare regulations.

  Launching a dynamic start-up business unit to maximize bottom-line performance.

  Leading development of promotional channels, advertising campaigns, and research projects.

  Rapidly identifying market penetration opportunities within the primary care practice segment.

  Promoting lucrative multi-channel marketing campaigns via market research and competitor analysis.


Professional Synopsis


Horizon Blue Cross Blue Shield of Xxxxxx, Trenton, XXXXXX 2017 Present


Quality Auditor II RN (Contract Role)

Lead forward-thinking quality auditing of medical record charts encompassing hospital services, healthcare treatments, standard Medicare reimbursement, and medical terminology for hospitalization re-admission denial appeals. Evaluate patient medical records, interpret provider documentation to identify quality of care issues (i.e. medical acronyms, abbreviations), and assess patient clinical stability at time of discharge and readmission. Document and prepare audit findings to determine validity of denial and / or quality of care issue.


Virtua Medical Group, Xxxxxx, XXXXXX 2017


GPRO HEDIS Auditor (Contract Role)

Strategically steered HEDIS chart abstraction analysis and medical record review for key plan metrics, clinical procedures, medication, and operational PQRS performance. Expertly audited clinical documentation to ensure assigned ICD codes were accurate and supported by diagnosis and plans of care. Evaluated performance levels, identified performance gaps, and prepared and submitted reports with quality improvement recommendations.


Continuum Health Alliance, Xxxxxx, XXXXXX 2015 2016


Product Marketing Analyst EMR Support

Utilized broad scope of industry knowledge toward researching Medicare / Medicaid, ACOs, and private payer trends, as well as the effects of value-based reimbursement on the transformation of private healthcare practices. Led targeted identification of market penetration opportunities in the primary care practice segment, including creating client profiles in Salesforce database, preparing revenue forecasts, and launching go live campaigns. Researched guidelines, developed work-flows and playbook, and contributed to the marketing plan of two new service lines per Medicare regulations. Exhibited skill in providing EMR support, triaging and resolving client user issues, managing multiple electronic interfaces, reconciling IDX errors, and interpreting HL7 messages.



Yyyyyy x. yyyyyy (xxx-xxx-xxxx Page Two


Regal Heights Healthcare & Rehabilitation Center, Hockessin, DE 2013 2014


Registered Nurse

Delivered excellence in daily medical administration for a 20-resident unit, including performing head-to-toe assessments and developing results-focused patient care plans while managing lab results; ordering, receiving, and accurately administering medication and insulin; and handling wound and / or tracheostomy care.


Beckley Nursing Prep, Bellmawr, XXXXXX 2011 2013


Nursing Instructor

Planned and presented dynamic nursing science curriculum instruction within a classroom environment of LPN students seeking Associate s Degree in Nursing Science and RN licensure. Designed practice tests and detailed PowerPoint presentations and / or lecture materials, as well as interactive clinical application scenarios.


Supplemental Professional Experience


Delaware Valley Industrial Resource Center, Philadelphia, PA 2003 2005


Marketing Program Manager

Expertly identified and built profit-generating business plans to resolve strategic marketing issues for C-Level clients, including participating in key projects for industry expansion, leveraging existing core competencies into new industries and market segments, analyzing industry competition, and researching quantitative marketing efforts, as well as continually promoting multi-channel marketing campaigns and product development.


Executive Greetings, Inc., New Hartford, CT 2001 2003


Marketing Director

Maximized bottom-line performance by directing a top-performing team of five marketing managers and two marketing analysts to promote the strategic direction of a five-brand business unit. Owned a $25-million profit / loss statement while managing a $5-million advertising budget. Developed brand-specific marketing plans.


Checks in the Mail, Inc., New Braunfels, TX 2001


Marketing Manager

Led strategic decision-making in driving lucrative profit / loss while developing innovative marketing plans and launching a start-up business unit. Supervised a two-member team of associate marketing managers tasked with product development, marketing channel management, and comprehensive product positioning.


Gaylord Brothers, Syracuse, NY 1998 2001


Senior Marketing Manager

Applied strong leadership talents toward directing two unique business lines generating $19 million and $2 million in revenue, respectively. Coordinated and managed a bid department while overseeing a staff of two product managers, one marketing analyst, and one bid department manager. Led development and execution of marketing plans, including promotional channels, advertising campaigns, product line management, and research projects.


Rapid Forms, Inc., Thorofare, XXXXXX 1994 1998


Product Manager

Profitably directed marketing initiatives, including driving all product line management, customer acquisition, mail pieces, merchandising, marketing research, financial database management, and monthly KPI reporting initiatives.


Education, Professional Licensure & Technical Summary


Master of Business Administration (Economics) Temple University

Master of Science in Marketing Temple University

Bachelor of Science in Nursing Thomas Jefferson University

Bachelor of Business Administration (Marketing) University of Notre Dame


Registered Nurse (No. 0000 xxxxxx xxxx , xxxx , xxxxx 00000900) State of Xxxxxx (Expires 2019)


EMR Platforms IDX Systems Multiple Electronic Interfaces CPT Coding ICD-10 HL7 Messaging


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