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Appeals Nurse Resume Example

Resume Score: 90%

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APPEALS NURSE
Executive Profile

Debora Messier Briggs, LPN. Nurse for 34 years. Current Bachelor Degree level college credits = 112. 3.5 grade point average. PHI Theta Kappa,High Honors student. Last position as Appeals nurse for NGS medicare.

Currently attending college for Healthcare Administration. Administrator for 14 years, Medical Case Management for over 7 years with diverse geriatric and pediatric population . Public health initiatives to improve Healthcare with the PA Department of Health. Quality measures and chart auditing and review included in case management position. Insurance Appeals nurse experience for NGS. Former Business founder/owner. Advocacy and Youth Pediatric Care specialties along with Mental Health, Neuro and developmental disabilities. Pediatric care is the majority of my nursing experience in Homecare. I would say 20 years in Pediatrics. Geri is 5 plus years and the rest acute Med Surg , trach and vent hospital. Scored a perfect 10 on Caliper test for management and leadership ability and success potential for success in management ,development , creativity and innovation. Familiar with DMEs, Support plans and DPW regulations. Former Director of Wellness in central NY area. Facility in New York now closed. Hire, training, interviews and staffing for 268 residents and large nursing team. Evaluations, reports and compliance, facility management when executive director away, staff meetings and fall risk, quality and documentation with some informatics. Familiar with Dementia and validation. Nurse for over 34 years, Business Development, administration, team building, staffing. Former fundraising and assistant administrator for non profit organization for 14 years. Board of trustees member. Med/Surg, vent and rehab, ICU, burn unit rotations , Extensive Developmental Disability, Behavioral, psych and neurological impairments experience. Administrative /Executive Experience, Business and extensive medical field diversity. Organized, analytical and prioritized. Extensive Service Coordination with Developmental Disabilities, mental health, Dementia and Geriatric Experience. Early Intervention Experience and Excellent writing/communicative skills. Presentation and coordination in both nursing and business management. Ability to assess, recommend and monitor progress in area of need. Great team player and leadership focused. Past experience in Clinical research in Public Health and Administration. Past Co contractor with MS society and Pennsylvania State Health Department. Clinical evaluations for Health care improvements in Pennsylvannia. PHI THETA KAPPA HONOR SOCIETY MEMBER.

Skill Highlights
  • Leadership/communication skills
  • Public Speaking
  • Business to Business liaison
  • Motivational
  • Servant leadership
  • Team building
  • Volunteer coordination and management
  • Project management
  • Human resources
  • Self-motivated
  • Employee relations
  • Small business development
Core Accomplishments

Volunteer Staff Development: 

  • Launched well-received program of professional development volunteer oversight for all staff.
  • Mentored and coached employees resulting in a 60% increase in productivity.

Implemented, founded and directed a Youth Camp for non profit organization by putting paid staff into position.Provided training and motivational leadership to team members.

Professional Experience
National Government ServicesFebruary 2015 to April 2015Appeals Nurse
Harrisburg, PA

Processed Medicare Appeals

Coding

CPT/ICD 9

Approval of Medical Necessity claims

Pennsylvania Elks Major ProjectsApril 2007 to August 2014Nurse Case Manager/ Care Coordinator
Harrisburg, PA

Nursing Case Management, Developmental Disabilities Experience with Adults and Pediatrics.

Oncology and Intellectual disability, Autism, Orthopedic Impairment, Cerebral Palsy, Behavioral Problems, Blindness/Severe Visual Impairment, Deafness/Severe Hearing Impairment, Epilepsy/Seizure Disorder, Mental Disorder, intellectual disability, Spina Bifida, Chemical Dependency, Speech/Language Impairment and other sensory impairment.

Nursing Case Management, Developmental Disabilities Experience with Adults and Pediatrics.

Oncology and Intellectual disability, Autism, Orthopedic Impairment, Cerebral Palsy, Behavioral Problems, Blindness/Severe Visual Impairment, Deafness/Severe Hearing Impairment, Epilepsy/Seizure Disorder, Mental Disorder, intellectual disability, Spina Bifida, Chemical Dependency, Speech/Language Impairment and other Neurological Impairments.

Referrals for Early Intervention.

Some Clinical research, data collection and organization in Public Health.

Medication Management, Advocacy, IEP and Insurance Appeals assistance, legal assistance, Public speaking and teaching.

Meeting with physicians and other providers to facilitate care coordination.

Work With EPIC ( American Academy of Pediatrics ).

Nursing Conferences.

MS Society Contracts and training in neurological impairments and medications.

Equipment location and exchanges.

Psychiatric and disabilities case management.

IEP advocacy, large coordination of Social Services.

Transition from Hospital to Home.

Physician interaction and working relationship for clients and needed treatments.

Medicare and Medicaid appeals.

SSI and SSDI appeals.

Some Clinical research, data collection and organization in Public Health.

Medication Management, Advocacy, IEP and Insurance Appeals assistance, legal assistance, Public speaking and teaching.

Meeting with physicians and other providers to facilitate care coordination.

Greater GraceFebruary 1992 to April 2004Administrator
Rome, NY
  • Co- administrator for non profit organization for 14 years.
  • Board of trustee treasurer for non profit - 12 years.
  • Community Outreach Volunteer
  • Special events coordinator
  • Fund raising
  • Advertising
  • marketing
  • Leadership Training
  • Motivational speaking
  • Teaching and training teams
Education
Excelsior College2016Bachelor of Science: Health Care AdministrationVerona, NY

Graduating in January 2016

Maryland Bible College and Seminary - Central New York Bible Institute1996BS: TheologyRome, NY, USA
Onondaga Community College1985AAS: Vocal PerformanceSyracuse, NY

Vocal Performance Scholarship

Mohawk Valley/Maria Regina College1982Select One: Liberal ArtsSyracuse, NY
Camden Central High School1981Diploma
Madison Oneida County BOCES1981Diploma: LPNVerona, NY
License
LPN Diploma - June 1981 License Number - PN270617 Expiration Date - 06/30/2016
Skills

Web site development

Teaching

Public speaking

Marketing

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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • National Government Services
  • Pennsylvania Elks Major Projects
  • Greater Grace

School Attended

  • Excelsior College
  • Maryland Bible College and Seminary - Central New York Bible Institute
  • Onondaga Community College
  • Mohawk Valley/Maria Regina College
  • Camden Central High School
  • Madison Oneida County BOCES

Job Titles Held:

  • Appeals Nurse
  • Nurse Case Manager/ Care Coordinator
  • Administrator

Degrees

  • Bachelor of Science : Health Care Administration
    BS : Theology
    AAS : Vocal Performance
    Select One : Liberal Arts
    Diploma
    Diploma : LPN

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