Maria Davalos

Performed IFP data mining and medical record abstraction for HEDIS measures (BCS, CBP, CCS, CIS, COL, EED, GSD, PSD) and conducted member and provider outreach to validate records during seasonal projects.

Conducted PPO record abstractions on the Inovalon QMRM platform for measures including CBP, GSD, EED, CCS, PPC, CIS and WCC, and engaged providers and members to obtain documentation.

Performed provider contact, record abstraction and overreads for Medicare products, abstracting TRC, COA, COL, LSC, child immunizations, CBP, eye exams, diabetes, BCS and PPC into Cotiviti.

Performed provider contact, record abstraction and overreads for Medicare products, abstracting TRC, COA, COL, LSC, child immunizations, CBP, eye exams, diabetes, BCS and PPC into QHSR.

Conducted provider contact, chart abstraction and overreads for Medicare products and entered HEDIS measures (TRC, COA, COL, LSC, child immunizations, CBP, eye exams, diabetes, BCS, PPC) into QHSR.

Provided remote call center services for Medicare Advantage plan enrollment and customer support as a licensed Florida insurance agent.

Performed Stars/HEDIS chart reviews and medical abstraction for measures including BCS, CBP, CDC, ABA, COA, MRP and TRC using MACESS/QHSR and executed provider/member outreach and overreads.

Conducted HEDIS chart reviews, overreads and provider/member outreach for measures (BCS, CBP, CDC, ABA, COA, MRP, TRC) and ensured vendor compliance during seasonal campaigns.

Provided home health pediatric nursing care across varied assignments, delivering patient-centered services and coordinating care with interdisciplinary teams.

Seasonal field interviewer for the Ryan White Program, collecting client service data, verifying program compliance and documenting community resources across multiple seasons.

Performed seasonal chart reviews and medical abstraction for measures (BCS, CBP, CDC, ABA, COA, PPC, ART), conducted provider/member outreach and reconciled duplicate or obsolete cases.

Managed patient flow, appointments, referrals and HEDIS gap abstracting/scheduling; performed follow-up for hospital/urgent care visits and prescription renewals to improve continuity of care.

Performed medical transcription for clinical documentation across hospital departments, ensuring accuracy and timely turnaround for patient records.

Transcribed medical reports and clinical notes, maintaining document accuracy and supporting hospital record-keeping processes.

Provided medical transcription services for clinical departments, ensuring timely and precise documentation of patient encounters.

Worked on workers' compensation medical transcription, producing accurate reports for occupational health cases and case management needs.

Completed a Medical Billing and Coding program at Miami Dade Medical Campus in 2013.

Completed the Practical Nursing Program (PN5189322) at Sheridan Technical Center from 2008 to 2009.

Completed high school at Hialeah-Miami Lakes Senior High School, graduated May 1982.