Rosalind Hughes, RN, CPC-A

Achieving accurate documentation of chronic conditions by reviewing patient medical records with ICD-10-CM codes and hierarchical condition categories (HCCs). Enhanced compliance in reimbursement processes for Medicare and managed care plans through validation of patient health status. Improved provider documentation accuracy by delivering targeted feedback on identified gaps.

Achieved high accuracy in remote record reviews through EMR access, extracting essential clinical data including labs, health screenings, transition of care, and immunizations. Contributed to health plan performance measurement against NCQA standards through precise data entry into systems. Delivered compliance with audit standards by ensuring accuracy in findings entered into specialized HEDIS software and databases.

Achieved high accuracy in remote abstraction of records for HEDIS measures by meticulously reviewing EMR-extracted records. Delivered compliant information for input into specialized HEDIS software for core measures including CBP, BCS, GSD, COL, TRC, CCS, and COA. Consistently met production goals while maintaining a 96% accuracy level during HEDIS season.

Oversaw nursing care operations for a group home serving over 50 individuals. Managed staffing and scheduling of nursing personnel to ensure adequate coverage. Collaborated in monthly human rights committee meetings to evaluate psychotropic medication usage. Led quality assurance initiatives through comprehensive record reviews to uphold state standards.

Coordinated care plans for pediatric patients to meet family needs and follow medical guidelines. Assisted multidisciplinary teams in enhancing patient outcomes through clear communication and resource allocation. Monitored patient progress and modified care strategies based on clinical assessments and family feedback. Informed families about treatment options, disease management, and preventive health practices to support informed choices.

Assessed and documented patient conditions to develop tailored wound care plans. Collaborated with multidisciplinary teams to ensure comprehensive patient treatment and recovery. Educated patients and families on wound management techniques for improved healing outcomes. Implemented evidence-based practices to enhance wound healing efficiency and reduce complications.