Alice Frost is seeking a Senior Manager position on the Quality Spectrum HEDIS® Advantage Team at Inovalon, Inc. She has over 12 years of experience successfully project managing HEDIS® reporting and quality improvement activities for health plans. Her experience includes managing client expectations, identifying issues, and conducting analyses that have improved HEDIS® measure rates by an average of 3.7% annually. She also has experience training staff, analyzing data, developing applications and presentations, and serving as Acting Corporate Director of Quality Management for a Medicare Advantage plan.

1. 1
Alice L. Frost-Dearing
401 Moser Lane; Knoxville, TN 37934 865.313.4005 poetallie@yahoo.com
Objective
I am seeking a Senior Manager position on the Quality Spectrum HEDIS® Advantage Team at
Inovalon, Inc.
Professional
Achievements
Health Plan and Hospital Quality Reporting
 Successfully project managed HEDIS® reporting and performed TQI activities as an employee for
4 different health plans with various product types (Commercial HMO/POS/PPO; Medicaid
HMO/POS; Medicare HMO/POS/PPO) for over 12 years. My average increase across the
HEDIS® Effectiveness of Care measure rates, year over year, has been 3.7%.
 In the last 5 years, partnered with assigned clients to bring over 30 HEDIS®/HIX-QHP reporting
submissions from start to successful finish across varied implementation and product types.
 Conducted gap analysis, root cause analysis leading to successful interventions to improve rates
on numerous HEDIS® measures including: Follow-Up After Hospitalization for Mental Illness;
Comprehensive Diabetes Care; Controlling High Blood Pressure; Breast Cancer Screening;
Medication Reconciliation Post-Discharge; and Childhood Immunization Status.
 Chosen as a member of a HEDIS® certified software vendor Product Advisory Board for 5 years.
 Managed client expectations and identified issues involving risk management to initiate early
intervention that would reduce client conflict and dissatisfaction.
 Developed and initiated a process to improve the accuracy of patient identification on medical
documents as part of a JCAHO accreditation intervention.
Contract Management
 Created a guideline for interpretation of contract language to identify specifications & service level
agreements for client purchasing quality reporting products and services.
 Conducted reviews and created summaries of over 30 client contracts.
 Identified 3-4 opportunities that would benefit clients and increase revenue for my employer on a
yearly basis.
Mentoring & Training
 Prepared and presented five presentations on the topic of medical claim data quality improvement
at HEDIS® audit firm and HEDIS® certified software vendor conferences.
 Created & presented numerous educational materials related to processes and industry topics for
coworkers, both within my team and from other teams.
 Recognized for successfully training new team members.
 Trained 36+ nurse reviewers to abstract and data enter medical record review information for
various HEDIS® hybrid measures using three different certified HEDIS® software applications.
Business Analytics
 Created the specifications for developers to create reporting to track authorized inpatient stays;
IBNR completion factors and medical service cost.
 Produced “ROI” analysis for product purchases and project development.
 Designed and created Microsoft Access applications to monitor client billing/invoicing and to track
client deliverables
 Performed data mining and research that identified an average of $1.5M per year in claim
overpayment/recoveries over a five year period.
 Served on claim system configuration team analyzing and identifying set up options to correctly
pay claims based on multiple provider fee schedules and contracts.
 Identified fraudulent practices involving incorrect use of diagnosis for maternity services and
incorrect unbundling of laboratory services.

2. Alice Frost 865.313.4005 poetallie@yahoo.com
Professional
Achievements
(continued)
Leadership and Management
 Made Acting Corporate Director of Quality Management for two years of a multi-market Medicare
Advantage health plan.
 Hired, trained and managed analytical staff.
 Developed project timelines, definitions and goals to enhance results and streamline processes.
 Managed & monitored reporting to support Senior Executive goals.
 Produced executive level presentations demonstrating S.W.O.T. analysis of corporate goals.
Skills  19 yrs. HEDIS® reporting
 11 yrs. Microsoft SQL Server® Management
Studio
 20+ yrs. Microsoft: Access, Excel, Word, Project,
PowerPoint, Outlook
 2 yrs. Microsoft InfoPath & OneNote
 2 yrs. Verisk, Tiermed®
 3 yrs. General Dynamics IT,
MedMeasures™(ViPS)
 7 yrs. McKesson CareEnhance® HealthPlan
Reporter™
 Software UAT and regression testing
 2 yrs. HIX/QHP Quality Reporting Subject
Matter Expert
 HIPAA Compliance
 3 yrs.Certified Six Sigma Green belt
Work History Product Service Manager Inovalon, Inc. Bowie, MD 2011 - present
Corporate QI Data Informatics
Analyst
HealthSpring, Inc. Nashville, TN 2007 - 2011
Business Analyst Covenant Health Knoxville, TN 2005 - 2007
Quality Assurance Business
Analyst
McKesson Corporation/McKesson Health
Solutions Newton, MA
2005 – 2006
Medical Management Quality
Improvement Business Analyst
CHA Health Lexington, KY 1996 – 2005
Sr. Patient Clerical Assistant University of Kentucky Hospital
Lexington, KY
1978 - 1996