Case management, disease management, and health coaching experience.
Experience working with many EMR systems.
ICD-9, ICD-10, and HCC coding experience.
Trained on Medicaid and Medicare rules and regulations
HEDIS Review Nurse Mahone Group Georgia MedicalJanuary 2013 to September 2013
June 2007 to June 2013Nurse Site Review Consultant Inovalon
I accurately and efficiently conducted medical record reviews and auditing services which required 80-90% of local traveling.
I scanned and downloaded relevant components of medical records to support reviews performed.
I communicated effectively and professionally with provider offices, clinics, hospitals, and other clinical facilities regarding review/abstraction procedures, CMS and HIPPA standards, as well as ICD-coding.
I performed payment integrity audits as well as fraud audits creating massive savings and recovery of funds.
I also worked independently conducting HEDIS Hybrid chart abstractions each year during the HEDIS review season.
I reviewed and abstracted pertinent medical data from EMR's and paper charts to support the hybrid and specialty measures.
HEDIS Review Nurse Judge HealthCare-CoventryJanuary 2013 to May 2013
HEDIS Review Nurse Rose International-AetnaJanuary 2012 to April 2012
HEDIS Review Nurse CSI Companies-WellCareJanuary 2011 to May 2011
HEDIS Review Nurse Health Care Support-AetnJanuary 2011 to May 2011
Medpropersonnel StaffingJuly 2009 to January 2010Nurse Case Manager
Temporary assignment at WellPoint/Blue Cross Blue Shield performing behavioral and clinical assessments to identify health needs of patients.
Provided thorough symptom assessments using established protocols.
Provided relevant health information, identified and/or coordinated specific health coaching plans to facilitate objectives and goals, and coordinated assessments by interfacing with provider and other health professionals.
Presented cases for discussion at Grand Rounds/Care Conferences.
Established and maintained supportive relationships with members and their families as necessary.
Grady Memorial HospitalOctober 2008 to March 2009Registered Nurse
Provided a wide range of nursing care services in areas of full health assessments, care plans, vital signs, EKGs, phlebotomy, catheters, feeding tubes, as well as IV and central lines infusions.
I also educated patients and their families on hematology and/or oncology disease processes, medical-surgical procedures, and other aspects of therapeutic regimens including medication and pain management techniques.
June 2006 to December 2008Staffing/Home Health Nurse
Maxim Healthcare Staffing Service.
TEMPORARY AGENCY ASSIGNMENTSMarch 2005 to December 2007
I provided in-home care for an elderly patient diagnosed with cancer.
Medication administration via peg tube, monitoring of vital signs, intravenous infusion therapy, as well as ostomy and wound care were some of my daily responsibilities.
I also assisted with ADLs.
Education and Training
Clayton State University2015Master of Science: RN to MSNMiami Lakes, FL
Broward Community College2007Associate of Science: LPN to RNPembroke Pines, FL