Shannon Walker
Buford
Summary
Healthcare professional with over 15 years of hands on experience in a fast-paced healthcare environment. Very motivated and compassionate about my work and job duties. Patient care and wellness is my strong focus which I'm very responsible and accountable for. Highly-professional and organized Healthcare Industry with a solid experience in managing and overseeing daily office operations in healthcare as well as coordinating medical and administrative staff to deliver high-quality Healthcare services. Possess excellent communication, leadership, and multi-tasking skills along with the basic knowledge of Medical principles, ter
Overview
22
22
years of professional experience
Work History
Quality Improvement Abstractor
Centene
12.2024 - 04.2025
- Used reference material to facilitate accuracy, clarity and completeness of Medical Records
- Interpreting complex clinical information and acting as a subject matter expert on clinical information
- Reviewing and comparing data abstracted from medical records by third-party vendor with the appropriate measure guidelines
- Researching any discrepancies found by reviewing medical records, claims data, and any other relevant information
- Identifying trends and documenting any errors found
- Applying structured auditing criteria to medical records to determine compliance with HEDIS standards
- Demonstrating expertise in the requirements and parameters of mandated HEDIS performance measures
- Maintaining productivity levels as determined by the Quality Improvement Department
- Accurately entering the results of chart audits into a database, Quality Reporter
- Monitoring progress towards completion of the annual HEDIS chart abstraction process
- Utilize various software applications to support HEDIS operations
HEDIS Over-reader
UHG/TotalMed
01.2024 - 03.2024
- Responsible for verifying that the data compiled is accurate for the measures outlined. They must be experts in HEDIS Rules of Abstraction and ensuring all work is in compliance with NCQA guidelines
- When errors are found, document the error as well as the specific changes that need to be made
- Assume as the second set of eyes on the medical data for validation
HEDIS Abstractor
AETNA/CVS
01.2023 - 05.2023
- Upheld HIPAA regulations and standards for protecting patient information.
- Retrieved medical data for physicians and patients.
- Secured confidential patient information from unauthorized access.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Performed quality assurance on data abstracted from medical records in support of annual Healthcare Effectiveness Data and Information Set (HEDIS) audit.
- Collected, organized and entered patient data into HEDIS tool systems
- Performed regular quality and validation assessments on patient data to verify accuracy
- Reviewing and comparing data abstracted from medical records by third-party vendor with appropriate measure guidelines
- Reached any discrepancies found by reviewing medical records, claims data and any other relevant information
HEDIS Specialist
Centene Corporation
07.2022 - 05.2023
- Followed all company policies and procedures to deliver quality work.
- Applied medical subject matter knowledge to improve IT systems and functions.
- Applied knowledge, data, information and workflow to develop evidence-based models for health information technology solutions.
- Led, facilitated and attended focus groups and meetings to strategize workflow issues.
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
- Operated computer-based systems to retrieve and store information and records.
- Researched and validated clinical data.
- Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
- Implemented healthcare systems for patient status monitoring.
- Ran quality metrics reports to maintain high standards of virtual care.
- Influenced care outcomes by implementing improvements and optimizing health information technology.
- Served as liaison between end-users and health IT team.
- Developed and updated health information systems and interfaces.
- Worked closely with subject matter experts to develop solutions and improvements for clinical systems.
- Managed digitization of paper records.
- Employed methods of identifying information, business and technical requirements to meet user complex and unique health information and technology needs.
HEDIS Quality Analyst
UHG, United Health Group
01.2022 - 06.2022
- Performed quality assurance on data abstracted from medical records in support of the annual Healthcare Effectiveness Data and Information Set (HEDIS) audit.
- Collected, organized and entered patient data into HEDIS tool systems.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Reviewing and comparing data abstracted from medical records by third-party vendor with the appropriate measure guidelines
- Reached any discrepancies found by reviewing medical records, claims data and any other relevant information
- Applied structured auditing criteria to medical records to determine compliance with HEDIS standards
- Utilized various software applications to support HEDIS operations
HEDIS Quality Improvement Specialist
Zing Health
03.2021 - 10.2021
- Documented and reported issues with compliance, standards of care and quality assurance requirements.
- Supports quality improvement HEDIS and program studies as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history
- Collects, summarizes, and trends provider performance data to identify and strategize opportunities for provider improvement
- Delivers provider specific metrics and coach providers on gap closing opportunities
- Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements
- Abstracting medical records and overread HEDIS data entry of even
- Advises and educates Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS in accordance with NCQA requirements
- Develops, enhances, and maintains provider clinical relationship.
Document Control Specialist
UHC (Equity Staffing)
11.2020 - 03.2021
- Modified and maintained tools to support operations and business process creation using Adobe Acrobat, SharePoint, Excel and Access capabilities.
- Prepared digital files, physical documents and work requests in compliance with company guidelines.
- Provided support for document controls and worked with contract documents.
- Proofread filenames, titles and submittal details to streamline submittal and avoid rejection.
- Transmitted documents, organized revisions and tracked changes.
- Maintained document control system including work instructions, procedures and associated databases.
- Performed document reproduction, printing documents from electronic sources such as email attachments, PDF files and cloud storage.
- Oversaw creation, routing and data input of bills of materials, ECOs, ECRs and ISO documents.
- Converted documents from one application to another, including cleaning, formatting and applying styles as needed.
- Manipulated and converted documents to meet needs for projects.
Medical Legal Assurance Specialist
BD Medical Inc (Reverse Merger, Contract Ended)
06.2019 - 12.2019
- Evaluated accuracy and quality of data entered into agency management system.
- Perform complaint and quality investigations related to manufacturing, design or clinical use issues.
- Review and approve investigations performed by OEM supplier. Managed large volume of medical claims on daily basis.
- Ensure consistency to detail in performing and documenting complaint investigations
- Evaluates complaints for determining MDR/Vigilance events and document rationale for not filing MDRs
- Determine whether a product malfunction or serious injury reports needs to be filed with the FDA.
- Determine whether a 30 day or 5-day MDR report is required. Maintain the records of all MDRs and document rationale for not filing MDRs.
- Perform final review for closure of complaint files to ensure accuracy, completeness and attention to detail.
- Generates results letters to customers and maintain all required records for the complaint.
- Approve decision trees for vigilance reports/international competent authority.
- Handle competent authority inquiries of complaints and other duties as assigned
HEDIS Abstractor/Consultant /Data Quality Manager
Integrated Research Inc.(AETNA-Contract Seasonal)
01.2014 - 05.2019
- Evaluated large datasets for quality and accuracy.
- Researched and determined scope and complexity of issues.
- Travel the state throughout GA, SC and 1N to healthcare facilities to perform chart review, abstraction and audits
- Extract data from patient medical records as part of healthcare reporting requirements for HEDIS.
- Enter extracted data into electronic files and a system tool.
- Maintain complete confidentiality of PID and assist with compliance and regulatory programs for preparedness and accreditation requirements.
- Organize and index all incoming medical records from multiple internal sources for chart auditing Generate the ability to handle various tasks in a fast- paced environment
- Administered, supported and monitored databases by proactively resolving database issues and maintaining servers.
HEDIS Abstractor /Medical Chart Auditor
Change Healthcare (merger)
10.2010 - 06.2014
- Reviewed charts and flagged incomplete or inaccurate information.
- Performed medical records review and abstraction in support of the annual HEDIS project
- Applied structured auditing criteria to determine compliance standards
- Reviewed and abstracted paper and electronic medical records and completed audits to determine if the quality of care measures, as defined by the NCQA for the years HEDIS audit has been met and entered findings in to data base
- Researched and compiled statistical data to support cost control and care improvement initiatives.
- Identified new methods to optimize medical records management.
- Maintained accuracy, completeness and security for medical records and health information.
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
- Managed quality assurance program, including on-site evaluations, internal audits and customer surveys.
Healthcare Analyst/Quality Improvement Specialist
Healthcare Consultant
01.2010 - 09.2010
- Developed quality improvement plans, policies and operational guidelines.
- Provide team leadership and project management
- Extracted, transformed and loaded data utilizing SAS ETL studio
- Responsible for researching health data and records by interpreting patient data into reports.
- Compile and analyze patient claims to access performance and efficiency relative to available medical models.
- Develop and provide regular reports from company's vendors and customers.
- Review all data from a variety of sources to ensure integrity, validity and accuracy.
- Assist with structuring of request programming.
- Create data sets for analysis using database and analytic tools.
- Presented presentations to the team for new business goals.
- Provide analytic support to patient quality improvement teams
HEDIS Abstractor
Healthcare Consultants
02.2008 - 01.2010
- Collect, analyze and report patient that fall into the core measure criteria.
- Abstract information and perform data entry into software that organize the statistics and submit the reports to CMS and Joint Commission for quality measures.
- Perform charts audit review. Identifies potential resolutions to problems identified in data collection.
- Manage the overall record retrieval process for abstracting the required stroke data and transmitted electronically to a national database.
- Conduct additional QI audit throughout the review.
- Communicate effectively with advocate and medical facilities to ensure the confidentiality of patient health information
Medical Records Director
Liberty Nursing& Rehab
05.2003 - 01.2008
- Maintained accuracy, completeness and security for medical records and health information.
- Interacted and communicated easily with department personnel and public.
- Adhered to all confidentiality requirements at all times.
- Demonstrate initiative by organizing and closing out all charts of residents in a 281 bed facility.
- Research all current and closed charts for appropriate forms and signatures.
- Manage a team of Ward clerks, and assist in their daily routines of maintenance of the medical records.
- Take on weekends duties, helped mealtime preparation, and perform hall monitoring.
- Create a functioning file method of filing medical records within compliance of the State of North Carolina.
Education
Bachelor of Science - Health Administration
Columbia Southern University
Orange Beach, ALCertificate - HEDIS/STARR Certified
Next Level Training
Atlanta, GAundefined
Kennesaw State University
Kennesaw, GAPost-Degree Certificate - Data Platform Solution Expert
Bridge Institute
Lilburn, GA02-2024
Bachelor of Arts - Paralegal Studies
Indiana University - Purdue University
Indianapolis, IN12-2025
Certification -
Microsoft Certified Azure Administrator Associate
02-2024
Certification -
Microsoft Certified Azure Data Engineer Associate
02-2024
Skills
- Computer: HEDIS, NCQA, CMS, Eclinical Work, Medtech, NextGen, Cairo, STNA, Advance Med, Allscripts, Athena Health, Cerner, Practice Fusion, AdvanceMD, ChartLogic, Greenway and Microsoft Office Suite
- HEDIS Review: QCAT, ECDS, Datalink,Careseed, Reveleer, NCQA, EMR, Diagnosis code, Microsoft word, Excel, Power point DARTH, HealthEC, QSHR, Optum, CareAnalyzer, SAP, Cognos EPM, Dash, DataVant, QMRM, Cotiviti, Epic,(Healthy Planet and Compass Rose), Acadia, MRO, Ciox, Axiom Software, Centauri
- Documentation abilities
- Scrupulous records management
- Operational improvement
- Problem resolution
Timeline
Quality Improvement Abstractor
Centene
12.2024 - 04.2025
HEDIS Over-reader
UHG/TotalMed
01.2024 - 03.2024
HEDIS Abstractor
AETNA/CVS
01.2023 - 05.2023
HEDIS Specialist
Centene Corporation
07.2022 - 05.2023
HEDIS Quality Analyst
UHG, United Health Group
01.2022 - 06.2022
HEDIS Quality Improvement Specialist
Zing Health
03.2021 - 10.2021
Document Control Specialist
UHC (Equity Staffing)
11.2020 - 03.2021
Medical Legal Assurance Specialist
BD Medical Inc (Reverse Merger, Contract Ended)
06.2019 - 12.2019
HEDIS Abstractor/Consultant /Data Quality Manager
Integrated Research Inc.(AETNA-Contract Seasonal)
01.2014 - 05.2019
HEDIS Abstractor /Medical Chart Auditor
Change Healthcare (merger)
10.2010 - 06.2014
Healthcare Analyst/Quality Improvement Specialist
Healthcare Consultant
01.2010 - 09.2010
HEDIS Abstractor
Healthcare Consultants
02.2008 - 01.2010
Medical Records Director
Liberty Nursing& Rehab
05.2003 - 01.2008
Certificate - HEDIS/STARR Certified
Next Level Training
undefined
Kennesaw State University
Bachelor of Science - Health Administration
Columbia Southern University
Post-Degree Certificate - Data Platform Solution Expert
Bridge Institute
Bachelor of Arts - Paralegal Studies
Indiana University - Purdue University
Certification -
Microsoft Certified Azure Administrator Associate
Certification -
Microsoft Certified Azure Data Engineer Associate
Similar Profiles
Noel BasnightNoel Basnight
Customer Service Advocate at CenteneCustomer Service Advocate at Centene
Johayri FelixJohayri Felix
Sales Support Administrator at CenteneSales Support Administrator at Centene
JASON KURMAN RN BSN RN-BCJASON KURMAN RN BSN RN-BC
Concurrent Review Nurse at CenteneConcurrent Review Nurse at Centene
Holly Lynne HardwickHolly Lynne Hardwick
Case Manager at CenteneCase Manager at Centene
Landon HarveyLandon Harvey
Entrepreneur at Jefferson High SchoolEntrepreneur at Jefferson High School