Elizabeth Hernandez

Oversaw management of 40,000+ commercial and Medicare patient lives and led teams of clinical coders, quality analysts, and client success to drive risk and HEDIS quality performance. Reduced inpatient admissions by 25% and achieved a 5.26/6.0 STAR rating while collaborating with finance and RCM on shared savings and coding strategy.

Managed 11 provider groups (56 physicians) and ~15,000 Medicare Advantage lives across three payers, designing process innovations to improve quality measures and provider satisfaction. Implemented training, reporting, and site visit programs that ensured compliance and drove enrollment and reporting improvements.

Coordinated discharge and transition-of-care outreach, provided chronic disease education, and collaborated with social workers and pharmacists to address barriers to care and improve post-discharge outcomes. Performed chart analysis to close quality measure gaps and maintained client records and reporting to demonstrate improvements.

Served as primary triage staff and EPIC super-user to improve clinical communication and workflow efficiency; supported complex care including pacemaker interrogations and patient education. Trained staff on EMR use and maintained accurate clinical documentation and reporting.

Completed a Bachelor of Science in Community Health Education with coursework in Psychology and Counseling, degree conferred August 1995.