Jessica Pedden

Leading success through focus on top quality, operational efficiency, and project management. Proven leader realizing the big picture by directing operations and overseeing delivery of high-quality, safe, and compliant patient care. Excellent communication and interpersonal skills, uniting organizational stakeholders to enact positive change and continuously improve operations while working towards strategic goals.

Regulatory compliance expert, maintaining up-to-date knowledge of rapidly evolving local, state, and federal policies.

Technical

Expertise in eClinical Works, NextGen, Epic, EBO, Cognos, PPM, and Microsoft Suite (Word, Excel, Outlook, Publisher, and PowerPoint).

Senior Manager Quality Analytics at Alameda Alliance for Health (2024-06 – Present)

Responsible for managing plan operations of HEDIS, Pay-for-Performance, DMHC Provider Appointment and Availability Survey (PAAS), designated Medicare D-SNP initiatives, Risk Adjustment activities including coding and chart review, additional incentive programs and other related projects with the required level of outcomes-based performance.

• Oversee and develop complex end-to-end operational processes to support a variety of quality-related projects including HEDIS, Pay for Performance, PAAS and other initiatives such as State driven incentive programs.
• Lead multi-departmental meetings and develop project plans to ensure all regulatory, NCQA and internal due dates and activities are met to achieve overall success of projects.
• Develop and implement Medicare D-SNP initiatives to support the Medicare Stars program, Risk Adjustment Program, and other D-SNP requirements.
• Develop and implement initiatives and tools to educate and improve provider adherence with appropriate coding and documentation requirements.
• Analyze and evaluate project performance, impact and outcomes.
• Collaborate and provide decision support and actionable insights to internal departments such as Quality Improvement and Provider Relations, and external entities to improve overall quality results.
• Collaborate with Healthcare Analytics team to develop and maintain reports and dashboards for internal and external use.
• Develop presentation materials and communicate project outcomes to various levels of customers, both internal and external.
• Management of vendors including vendor selection, contract oversight and routine meetings/communications to ensure vendor performance standards and service level agreements are met.
• Provide leadership and mentor team with use of business knowledge and subject matter expertise.

Manager Quality Analytics at Alameda Alliance for Health (2021-10 – 2024-06)

Provide insight and decision support through the collection, continuous monitoring, and analysis of the Plan's performance using HEDIS data. Manage and coordinate the Plan's HEDIS operational activities, annual audits, and rate submission to ensure that all regulatory deliverables are met. Provide oversight and manage the Plan's annual fielding of the Provider Appointment Availability Survey.

• Participate in internal and external QI workgroups to support and provide insight that will help improve the Plan's quality performance.
• Manage the Pay-for-Performance workgroup in the development of the Plan's annual provider incentive program.
• Support the Chief Analytics Officer with the oversight of CalAIM Incentive Payment Program through the development of the provider application process and oversight of the quantitative and qualitative submissions to the Department of Healthcare Services.
• Supervise and mentor the Quality Analytics Team.

Clinical Quality Manager at Alameda Alliance for Health (2019-05 – 2021-10)

Coordinate delivery of high-quality patient care in accordance with organizational expectations, acting as a liaison to reinforce standards and compliance requirements through training, presentations, and discussions. Uphold performance standards, building policies and procedures to govern staff. Enforce evidence-based decision making, reporting on key performance indicators to senior leaders through periodic reviews.

Drive continuous improvement, managing QI staff (clinical and nonclinical staff) and uniting cross-functional teams around quality and improvement initiatives.

• Emphasize provider quality through design and execution of data driven quality improvement projects focused on HEDIS measures.
• Assisted in development of the Plan's annual Quality Improvement Trilogy Documents.
• Supported QI Leadership with audit readiness with the Department of Healthcare Services and California Department of Managed Health Care.
• Participated in discussion on the development of the Plan's annual provider incentive program.

Compliance Officer at Community Health Center Network and Alameda Health Consortium (2018-05 – 2019-04)

Adhered to local, state, and federal requirements, establishing policies and focusing routine quality control audits and inspections. Promote compliance across all sites through creation of a company culture and staff training based on a comprehensive corporate compliance program. Aligned compliance efforts with current requirements through annual compliance planning and revisions, identifying priority compliance risks to reduce fraud, waste, and abuse.

Maintained knowledgeable staff through routine training on State and Federal standards, policies, and procedures. Supervised fraud, waste, and provider disputes, cultivating relationships and providing resources for member health center staff.

• Spearheaded organizational compliance with DHCS regulations.

Consultant at Vesta Healthcare Liaisons, LLC (2017-01 – 2018-06)

Optimized patient care by streamlining workflow and productivity, analyzing operations to identify and address areas of opportunities. Mitigated risks engineering policies applying State and Federal guidelines. Cultivated growth to meet business objectives while growing access to care in underserved areas, analyzing feasibility of new clinics through performance of Community Needs Assessments.

Transformed clinic operations to meet Payment Reform, HEDIS, Meaningful Use, and Patient Centered Health Home standards, applying knowledge of requirements to create and manage cross-functional teams through change initiatives and projects. Maximized resource use, translating business objectives into strategic action plans and developing clinic budgets.

• Improved reimbursement, metric reporting, and patient care, building a custom template to optimize the Electronic Health Records Systems.
• Built practice sustainability for newly acquired private practice through creation of appropriate infrastructure.

Chief Operating Officer at Bay Area Health Center (Formerly Tri-City Health Center) (2015-11 – 2017-03)

Realized company objectives partnering with the CEO to head program operations according to strategic plans and business expectations. Met performance expectations, monitoring Key Performance Indicators to review successes and design solutions for shortfalls. Orchestrated completion of daily tasks, supervising staff, determining and assigning workloads, monitoring productivity, and initiating training and corrective action plans as required.

Led compliant operations, writing policies and protocols to empower staff and improve service quality. Preserved financial expectations by minimizing costs while maximizing clinic program and service effectiveness, collaborating with other executives to craft operational budgets, prepare financial forecasts, and monitor adherence through review of monthly expenditures.

• Enhanced and revised Nextgen workflows to improve clinical support staff and provider efficiency.
• Elevated financial performance and patient care by expanded scope of service to integrate behavioral health and dental services into primary care.

Quality Assurance Director at Foothill Community Health Center (2013-04 – 2015-10)

Ensured compliance across medical, dental, behavioral health, optometry, CPSP, health education, and nutrition through design, implementation, supervision, and review of QA compliance plans. Aligned staff around quality focuses, coordinating monthly QA meetings to align all departmental directors. Strengthened community reputation and patient retention, establishing an Ombudsman Program to address patient complaints and creating initiatives to enhance overall engagement.

Enrolled providers into state and federal programs, including FPact, PECOS, CAQH, and CHDP. Spearheaded compliance with certification and licensing, tracking and ensuring fulfilment of all requirements and heading all reporting.

• Extended organizational reach by increasing school clinics from two to seven.

Innovations Program Manager at Foothill Community Health Center (2013-04 – 2015-10)

Organized on-time delivery of Innovation Department projects, managing processes end-to-end from defining of scope to formalizing timelines and navigating risks. Supported operations by securing required funding, managing grant processes end-to-end from identification to writing and submitting of grant applications. Enforced healthcare reform, implementing strategies and liaising with stakeholders to ensure adoption.

• Revitalized eCW use, overseeing staff and provider training, generating reports, and creating standard operating procedures and templates.
• Reinforced compliance with local and federal quality standards, writing comprehensive quality monitoring system.

Clinic Manager for the School Based Health Centers at Foothill Community Health Center (2013-04 – 2015-10)

Encouraged community health leading Health Education RNs and Nutrition Department operations at nine school-based clinics. Expanded use of budget funds, negotiating competitive prices with local vendors to secure inventory for clinics. Demonstrated clinics' value through routine reporting, demonstrating the improvement in academic success from providing healthcare.

Bolstered community health, administering preventative care events including blood pressure screenings, glucose testing, and vaccination and immunization clinics.

• Enhanced services by founding and enacting Call Center and Referral Department infrastructures.
• Commanded improvement of clinical and administrative performance through oversight of ICD-10 transition from ICD-9 and EMR system upgrade.

Compliance Officer at Foothill Community Health Center (2012 – 2013)

Trainer at Heuristic Associates (2003 – 2011)

Intern at CoreStaff (2002 – 2002)

Fund and Program Development Assistant at Foothill Community Health Center (2012 – 2012)

Master of Science in Quality Assurance in Healthcare – California State, Dominquez Hills

Bachelor of Science in International Business – Pepperdine University