- www.linkedin.com/in/dr-rachel-leier-dnp-aprn-cnp-160238b0
Doctoral prepared Certified Nurse Practitioner very interested in the SIU Insurance Fraud Analyst position. During the last ten years working as a successful nurse practitioner in the field of Emergency & Urgent care medicine, treating a variety of patients from trauma, pediatrics to geriatrics. Currently experienced in Medicare/Medicaid fraud, potential healthcare waste & abuse. Performed years of medical research & most recently involved with Medicare fraud up-coding Qui Tam case involving a physician group. Current career focus is on providing quality medical consulting & investigating to eradicate health care fraud to provide a better future for all of us. Current responsibilities include gathering & reviewing information, investigating claims for medical necessity, analyzing, and reviewing other various information assessing for potential patterns of abuse, wasting of dollars & illegal billing practices. Recognized for providing a detailed oriented, dependable, and organized reports. Strongly committed in helping to eradicate medical fraud & abuse. Commended for impeccable attention to detail, working under strenuous deadlines & demonstrating proven initiative to be a self motivator with successful drive own business.
- NP Acute Urgent & Emergency Care (Adult/Pediatric) experience
- Invaluable 25 years of previous (RN) Emergency Department patient care experience
- Exceptional oral, written & listening communication style
- Expert in EPIC (Electronic Medical Records)
- Review medical records for medical necessity and up-coding per Medicare /Medicaid guidelines
- Organize, review and analyze records related to providers submissions to Medicare assessing for fraud & abuse
- Summarize final reports including final conclusions, key concepts, explanations of medical terms and procedures, strengths/weaknesses of discoveries, recommendations for further medical expert participation
| - Participate in authoring deposition questions
- Experience with Qui Tam case involving Medicare fraud by provider up-coding
- Seasoned in medical clinical procedures and medical practice
- Review & analyze pleadings, complaints and discoveries
- Experience in medical billing, coding & auditing
- Adheres to all regulatory, compliance & legal policies
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Professional Work History
Legal Nurse Consultant, 04/2017 to Current
Leier Medical Consulting – Shakopee, MN
- Review medical records for medical necessity and up-coding per Medicare /Medicaid guidelines
- Organize, review and analyze records related to providers submissions to Medicare assessing for fraud & abuse
- Summarize final reports for attorneys including final conclusions, key concepts, explanations of medical terms and procedures, strengths/weaknesses of discoveries, recommendations for further medical expert participation
- Participate in authoring deposition questions
- Experience with Qui Tam case involving Medicare fraud by provider up-coding
- Seasoned in medical clinical procedures and medical practice
- Review & analyze pleadings, complaints and discoveries
- Experience in medical billing, coding, & auditing
- Adheres to all regulatory, compliance & legal policies
DNP Doctor Nurse Practitioner, 06/2015 to 04/2020
Allina Health Systems/ Urgent Care – Minneapolis, MN
- Completed physical examinations for acute illness & injury for adults/pediatrics through all ages
- Reviewed medical histories, chief complaints, lab & x-ray results and information gleaned during examinations to properly diagnose illnesses and/or conditions
- Assessed diagnostic radiology films and in collaboration with radiologist when needed
- Worked with patients and families using shared medical decision making model which allows them to be part of medical treatment & decision making process which makes for more patient-centered approach to their own healthcare for improved patient outcomes
- Advocated for patients & families
- Reviewed medical coding procedure with new hires
- Facilitated ongoing assessments and plan of care for patient & family needs
- Implemented interdisciplinary team approaches for patients as needed
- Applied splints for soft tissue orthopedic injuries, sutured lacerations including adult/pediatrics, (including delicate facial wounds) assessed soft tissue injuries, skin infections, abdominal pain, back pain, stabilized chest pain and transfer to Emergency Department, neurological emergencies, incision & drainage & more
- Exceptional EKG interpretation
- Served as Lead Nurse Practitioner for Express Care Clinics
- Developed & newly authored Manual for Treatment Guidelines for providers (NPs/PAs) for use in medical practice for freshly built Allina Express Convenience Care Clinics
- Discussed preventive measures to improve health (i.e. Smoking cessation, BP lowering through diet and exercise, importance of taking regular medications daily) to avert further medical issues within time constraints of Urgent Care
- Discussed discharge instructions with patients and explained proper use of home medications including side effects & warnings
- Met with approximately 16-18 patients each day in Urgent Care Clinics with varying levels of acuities
Certified Emergency Nurse Practitioner, 11/2014 to 01/2015
Emergency Care Consultants – Minneapolis, MN
- Worked under intense pressure in emergency environment
- Listened attentively to patient concerns and obtained problem-focused histories, and performed complete and thorough physical examinations
- Administered emergent & acute care to patients with acute & chronic and conditions
- Employed mutual decision making processes directly with patients & families regarding their ED care, to create more patient involvement and better patient outcomes
- Provided exceptional patient care for acute critically ill patients life-threatening illnesses and traumatic injuries
- Evaluated 8-12 patients each shift, assessed vitals and attained key case information
- Discussed discharge instructions plans with patients and their families. Explained test results and proper use of home medication
Certified Family Nurse Practitioner, 05/2014 to 10/2014
Minute Clinic – Chanhassen, MN
- Reviewed medical histories & current complaints
- Provided medical services & evidenced based care to patients with acute conditions, including upper respiratory infections & minor conditions
- Completed physical examinations & required immunizations for school-aged patients
- Performed analysis of (UA, Influenza, Rapid Strep & Mononucleosis testing as needed and reviewed test results & information gleaned during examinations to properly diagnose illnesses and conditions
- Discussed preventive measures to improve health and avert further medical issues
- Worked with patients & families to explain plans of care, advocating for their needs and preferences & reviewed discharge instructions
- Attended quarterly patient case conferences & staff meetings to educate staff & facilitate good communication
Executive Team Leader /Certified Family Nurse Practitioner, 06/2012 to 04/2014
Target Clinic – Chaska, MN
- Monitored monthly census, created schedules for staff approved vacations & time away, worked with staff conflict resolution & reviewed medical charting of staff employment evaluations
- Orchestrated sport physical exam schedules for patients vs. previous open visits (non-scheduled) to allow for early am and late pm appointment times which increased clinic's goal for more flexibility for patient exams from 30% to 67% in 6 months by organizing work flow. This allowed keeping current patients, & capturing new patients concurrently
- Distributed individual assignments to team members & monitored progress against patient satisfaction scores & patient volumes; both increased 66% from previous year
- Redesigned Executive Team Lead & Nurse Practitioner position as dual role with active clinical time participating in seeing patients in addition to managing duties. This allowed for more problem-solving, ability to think big picture & reduce process inefficiencies
- Resolved departmental problems, improved operations & provided exceptional patient and staff support
- Implemented new marketing strategies (i.e. First-aid kits with Target logo and clinicians business cards included for follow up) within clinic which resulted in 67% increase in patient volume
- Launched flu shot clinics for Target store employees which significantly optimized compliance with flu vaccines which helped to drive healthier staff
- Recruited and hired talented individuals bringing depth & experience to organization
- Mentored employees to help improve skills and enable team members to become peak performers on job
- Built relationships with team members to encourage willingness to address concerns & issues
- Cultivated productive and safe atmosphere while supervising team of four employees working within retail clinic while also collaborating with pharmacy team
- Kept work areas clean, organized and safe to promote efficiency & team safety
- Held meetings with employees to evaluate performance & make plans for improvement
- Continuously checked lab and blood testing kits products for quality assurance according to strict guidelines
- Reviewed lab machine component quality to assess quality performance daily for all staff
- Created weekly newsletters by email for staff, focusing on staff communication and other important details, this was well receptive. Copy was forwarded to Group Director
- Monitored monthly census, created schedules for staff approved vacations and time away, worked with staff conflict resolution reviewed medical charting of staff employment evaluations & conflict resolution reviewed medical charting of staff employment evaluations
Doctorate- DNP: Doctor of Nursing Practice, 08/2016
Rocky Mountain University of Health Professions - Provo, UT
- Graduated with 3.91 GPA
- Graduated summa cum laude
- Member of Sigma Theta Tau International Honor Society
Master of Science: Family Nurse Practitioner, 04/2012
University of Mary - Bismarck, ND
- Graduated in Top 2% of Class
- Graduated with 3.94 GPA
- Graduated summa cum laude
- Member of Sigma Theta Tau International Honor Society
Bachelor of Science: Nursing, 05/1992
University of Mary - Bismarck, ND
