Diane Sellers

Data Analyst Support - Health Department | Diverse Services - Remote, Contract

(2025-01)

Health Records Management | Long Term Care - Diverse Services - Remote, Contract

(2024-12)

Auditing and abstracting medical records. Participated in a team project to enhance data quality, achieving a 20% improvement in data accuracy. Collaboration with care team to ensure patients receive timely authorizations services.

Analyzed large datasets using SQL and Python, identifying key trends and patterns, which improved data-driven decision-making by 30%. Prepare work/ spreadsheets to collect and support chart review findings. Conducted in-depth data analysis to support business strategy development, contributing to a 15% increase in operational efficiency.

Facilitate and obtain appropriate provider documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality and complexity of care for the patient. Collaborated on a project to streamline data collection processes, reducing data processing time by 25%. Provide comprehensive analysis of clinical and non-clinical data for scientific communication including clinical evaluation reports.

Assisted in the development of an automated reporting system using Python, which increased report generation efficiency by 40%. Establish and maintain professional networks to

Patient Navigator | Long Term Care - CareSource

(2016-09 - 2024-12)

In this position the services provided is alerting CM of late annual assessments/FSA/ HRA and initial assessments. Alerting CM of new MyCare member as well as Partnering with CM to resolve issues that arise for MyCare LTC Member. Controlled the decrease in hospital/SNF stay. Governed the follow up outreach for Member transitioning back into the community. Actively build and maintain rapport with CMs Long Term Care Facilities. Authorized reporting fraud through claims and recording that information on master sheet to provide to UM department. Review assessments, claims and documentation history to discuss with assigned CM. Collaborating with LTC facilities to ensure MyCare Members doctor's appointment are scheduled and needs are met. Advised collecting/managing and monitoring the status of patient medical records along with documentation. Advised to specific CM pertaining to Member CTP goals.

Education provided to LTC members and staff regarding medical benefits.

• Assist with claims management and cost shares
• Assist with denial letters and expedited appeals
• Run daily reports and oversee discharge surveillance
• Research claims for ER visits, hospitalization, ER systems, doctors' visits, specialty visits, room-in-board, specialized equipment and more
• Compile data audits and maintain compliance standards
• Manage daily pre-registration needs for inpatient and intermediate care events
• Data transfer from HEDIS measures, utilizing CCA and Altruism System
• Actively tasking CM to follow new SNF Members
• Pulling Vendor reports and transferring data to master tracker
• Assigning correct ICD codes over to new system
• Controlled HCC project- emailing, faxing letters of Member's major/chronic diagnosis to PCP's and transferring data to large spread sheet for the UM department
• CareStar project (product line under CareSource)-transferring data to private Q drive
• Enforced passion of data analysis and quality assurance

Bachelor of Art - Psychology - Northcentral University

Associates of Science - Social Work - Cuyahoga Community College