Donna Norris-Cell (505) 304-7590

Professional Profile
Over 20 years of experience in the healthcare industry
Demonstrated ability to communicate, problem solve, and work effectively with people.
Work independently and handle multiple projects simultaneously.
Excellent problem-solving skills and detail oriented. Strong analytical skills.
Knowledge of insurance benefits, ICD-9, DSM IV TR, DSM 5 diagnostic coding and CPT4, HCPC, REV coding
Ability to take initiative and see tasks to completion.
Flexible and comfortable working in changing environment
Knowledgeable in using MS Word, Excel and Power Point
Professional Experience:
Molina Health Plan
Albuquerque NM
HEDIS Specialist (Temporary Assignment) (January 2015 to May 2015)
Collection of medical records state wide for both chart and electronic health record reports from provider offices and
hospitals based on member needed services. Reports and gaps data are loaded into the HEDIS application. Trained in the
abstract process for cleaner medical record retrievals.

Provide data collection and report development support for Quality Improvement studies and performance improvement
projects.

Assists the Director/Manager in the coordination and preparation of the HEDIS medical record review which includes
ongoing review of records submitted by providers and the annual HEDIS medical record review project.

2004 to January 2014

Lovelace Health Plan
Albuquerque NM
HEDIS Project Coordinator (October 2012 January 2014)
Assisted in preparation & coordination of collected medical records received by providers for annual/ ongoing HEDIS review
Analyzed reports to identify gaps in care & compliance
Participated in HEDIS Team meetings to meet Company goals
Designed innovative strategies to positively impact HEDIS Scores including developing health literate outreach letters,
provider education materials & member education materials
Supported development & implementation of health promotion outreach campaigns at community & employer group
events
Entered HRAs & provided referrals for Disease Management, Case Management & Behavioral Health Departments
Case Management Coordinator (January 2011-October 2012)
Performed ongoing monitoring of the plan of care to evaluate effectiveness.
Reviewed back flowed claims for appropriateness of claim payment request
Conducted assessment of member needs by collecting in-depth information from the member, members family/caregiver,
hospital staff, physicians and other providers.
Responsible for contacting members/patients post hospitalization to assure member compliance with physician
appointments, home health care and/or durable medical equipment
Manages and completes assigned work plan objectives and projects in a timely manner.
Documents care plan progress in information system.
Hospital Case Coordinator-Discharge Planning (October 2009 January 2011)** Lovelace Health Plan Case Mgmt at LMC**
Responsible for coordinating and overseeing a variety of departmental projects such as assigning hospital
admissions/assignments to Case Managers, coordinating delivery of Durable Medical Equipment i.e.; front wheeled
walkers, portable oxygen tanks, nebulizers & canes before patient discharge. Management of Kronos time sheets.
Reviewed back flowed claims for appropriateness of claim payment request .
Assists orientation and mentoring of new team members as appropriate.
Submitted post hospitalization referrals for Skilled Nursing, Inpatient Rehabilitation, Home Health Care, dialysis chair
arrangements, durable medical equipment including wound vacs.

Health Services Assistant-UM Prior Authorization (September 2004 October 2009)

Verified insurance and eligibility
Processed emergent/elective and transitional prior authorization requests meeting guidelines. Completed calls and faxed
requests timely.
ICD9/CPT4, DSM4/DSM5 coding experience and medical terminology.
Participated in a pilot project that transitioned faxed MRI/CT scan authorization requests to an intranet application
Reviewed back flowed claims for appropriateness of claim payment request
May 2003 September 2004
Cimarron Health Plan
Albuquerque, NM
Case Management Processor-Case Manager 1
Managed Commercial & Medicaid Salud member transplant and oncology cases where the clients needs have been
identified as requiring assistance navigating the health care system.
Processed requests for out of state travel arrangements & facilitated communication between the health plan & transplant
facility coordinators.
Researched available resources to assist in the members unique needs outside of health insurance benefit.
Behavioral Health Intake Coordinator- Health Services Assistant (August 2001 May 2003)
Worked as a liaison for a new Behavioral Health Department when MCOs took over the responsibility of prior authorization
for appropriateness of behavioral health treatments and educated Providers of Prior Authorization processes to streamline
turnaround timeliness. I worked with the three Behavioral Health Providers, PMS for northern NM, Aspen for Albuquerque
metropolitan and surrounding areas and Rio Grande for southern NM. These three entities provided prior authorization for
behavioral health treatments prior to this change.
Intake for new incoming requests for prior authorizations via phone or fax and routed to reviewer.
Reviewed back flowed claims for appropriateness of claim payment. Entered prior authorizations from the three entities for
remaining treatments available. Worked closely with the three previous behavioral health facilities to ensure accuracy of
claims payment and prior authorizations. Completion of all old scrubbed claims (thousands upon thousands) from October
with deadline of February and completed the task in January.
Education:
Del Norte High School
Albuquerque, NM
High school Diploma
Certifications:
Franklin Medical College
Albuquerque, NM
Medical Office
References:
Martin Ethridgehill-Quality Operations Manager-Presbyterian Health Care Services
Methridgehill@aol.com
Cell: 505-264-6558
Aislinn Mathews-Graham-HEDIS Interventions Manager-Molina Health Care
Aislinn.Matthews-graham@MolinaHealthCare.com
Work Phone: 505-348-0528
Cell: 505-321-8106
Marta Lynn Larson-Director Quality Improvement Quality Management-Molina Health Care
Marta.larson@molinahealthcare.com
Work Phone: 505-348-0940