Kim Dorsey
Hedis Nurse Reviewer @Elevance Health (Formerly Anthem)
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WORK HISTORY
Hedis Nurse Reviewer @Elevance Health (Formerly Anthem)
US
Elevance Health, formerly Anthem, Inc, is a healthcare company that provides health insurance, care management, and other clinical services.• Performed clinical data analysis and research within the Elevance data systems and internal claims systems to review medical records in a high-production environment with measured productivity requirements and required module testing.• Implemented NCQA standards to review medical records and abstract data for 14 HEDIS Medicare and Medicaid measures, achieving recognition for accuracy ratings over 95%, and placement on special TRC project team.• Navigated internal claims systems, inpatient/outpatient medical records, admissions and discharges, outpatient therapies/treatments, medical procedures, and tests, generating 20+ verified, accurate reviews per day.• Worked in HIPAA-compliant home office space with double monitors and a PC.• Utilized Microsoft Office and Excel, as well as Cotiviti and Quality Reporter health management platforms.• HEDIS MY24 Measures: TRC, EED, BPD, CBP, CCS, CIS, COA, GSD, IMA, PPC, DEV-CH, HPCMI-AD, LSC, WCC
ABOUT KIM DORSEY
Contact: k••••••••@gmail.com As a Clinical Quality Nurse, I focus on…
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