Jerika Avington

I work in healthcare operations, specializing in Medicare and Medicaid risk adjustment, claims auditing, and compliance. I review and validate medical and benefit data to ensure accuracy, identify workflow inefficiencies, and implement process improvements that align with CMS guidelines. My background includes over 10 years of experience supporting data integrity, regulatory compliance, and performance tracking in high-volume managed care environments.

I am a healthcare operations specialist with over 10 years of experience in Medicare and Medicaid risk adjustment, claims auditing, and compliance. My background includes reviewing and abstracting medical and benefit data, validating eligibility, and ensuring alignment with CMS regulatory guidelines. I have a proven track record of identifying workflow inefficiencies, analyzing system irregularities, and implementing corrective solutions to improve accuracy and performance.

I’ve worked across government, private, and managed care environments, including TennCare, Aya Healthcare, and the Department of Veterans Affairs. In these roles, I’ve conducted quality control reviews, developed reporting tools, and collaborated with cross-functional teams to strengthen data integrity and support audit readiness. My expertise spans risk adjustment, process improvement, EMR systems, and documentation accuracy, with consistent success in high-volume, remote, and compliance-driven settings.

I earned a Master of Health Care Administration (MHA) from Champlain College, where I developed advanced expertise in healthcare operations, compliance, and organizational management. This degree strengthened my ability to oversee data integrity, regulatory alignment, and process improvement initiatives. I also hold a Bachelor of Arts in Psychology from the University of Memphis, which provided a strong foundation in analytical thinking, communication, and understanding human behavior — skills that enhance collaboration and accuracy in healthcare data abstraction and compliance work.