Raelynn Kelly

Conducted comprehensive clinical quality audits across multiple lines of business, performing HEDIS abstraction, over-reads, and supplemental data audits with 99-100% accuracy. Collaborated with cross-functional teams to resolve discrepancies and supported organizational readiness for quality reporting cycles.

Contacted provider offices to request charts and verify documentation availability, coordinated HEDIS medical record review processes, and performed high-volume abstraction and over-read auditing with 98.5% accuracy. Participated in meetings with vendors, National Over-Read, and Regional HEDIS teams.

Retrieved medical records and clarified documentation needs with provider offices, conducted abstraction using Darth and Cotiviti, and performed data mining via Quest and LabCorp. Participated in MRR and supplemental data validation, identifying documentation trends and escalating findings to Quality Improvement.

Performed medical record abstraction using IPA Portal Provider and QMRM, ensuring accurate file naming and documentation review per HEDIS guidelines. Supported provider outreach for timely chart submission.

Coordinated assessments, care plans, and medication compliance, reviewed medical records to determine medical necessity and level of care, and collaborated with families and providers to close care gaps. Built strong patient relationships and served as a health advocate.

Completed daily abstraction and over-read auditing with 95%+ accuracy, coordinated chart submissions and provider communication, and identified documentation trends and improvement opportunities.

Monitored patient conditions and documented medication reactions, served as a liaison between physicians, staff, and families, and educated families on preventive health and care coordination.

Performed abstraction and quality auditing with 98%+ accuracy, provided coaching comments to ensure compliance with HEDIS specifications, and managed high-volume caseloads independently while meeting strict deadlines.

Conducted monthly telephonic assessments and ensured medication compliance, encouraged preventive services and coordinated communication between practices and patients, and ensured regulatory compliance through precise documentation.

Reviewed patient files and documented diagnoses and treatments, assigned codes aligned with HEDIS domains and ensured high-accuracy reporting.

Educated patients on nutrition, fistula care, and medications, and reduced infection rates by 15% as Infection Control Manager.

Managed patient care and nursing activities in LTC/Rehab, provided care management for complex conditions and initiated preventive screenings.

Medicare Chronic Care Management Certification obtained in 2019.

Licensed Practical Nurse (Compact License) from Chattahoochee Technical College in 2017.

HEDIS/QARR Certification obtained in 2017.

Associate of Applied Science in Computer Science from Monroe College in 1994.