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registered nurse redetermination auditor resume example with 16+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary
Registered Nurse  30 years experience in healthcare for a diverse population. Skilled in providing  all types of nursing care in hospital, home care. The most recent experiance is in Medicare Reimburancement and Medical Review for Medicare claims at a large insurance company.
Skills
  • Intravenous therapy comprehension
  • Diagnostic tools familiarity
  • Diagnostic tools familiarity
  • BAC screening/drug screen collection understanding
  • BAC screening/drug screen collection understanding
  • Patient evaluation/intervention
  • Professional bedside manner
  • Adept at prioritizing/managing deadlines
  • CPR certification
  • Venipuncture/blood draw expert
  • Trained in pre- and post-surgical care
  • Trained in pre- and post-surgical care
  • Proper NG tube insertion and removal
  • Competent in physical assessments
  • IV drug therapy management
  • Tracheotomy care comprehension
  • Foley catheter insertion/removal
  • Insulin medication assistance understanding
  • Client relations aptitude
  • ICD 9 forms specialist
  • Medical laboratory procedures talent
  • Seasoned in medical clinical procedures
  • Patient and family advocacy authority
  • Patient and family advocacy authority
    Medicare Redetermination Auditor for Medicare reimburancement for a large insurance company for Part A Medicare and Part A of B Medicare. Working with CMS and the new MAS computer support system for redetermination claims.
Work History
Registered Nurse Redetermination Auditor, 06/2011 - Current
Hillcrest Family Services Wapello, IA,
  • Audits and adjustments for payment of Medicare claims. The audits were for all Medicare reimbursement of patient claims by evaluating for supporting medical information. The Provider of medical information was informed of the decision for payment or return of Medicare payments. This was done for all types of Medicare paid claims of Medicare Part A and Medicare Part B of A claims.
Registered Nurse, 08/2009 - 06/2011
Nebraska Medical Center City, STATE,
  • Interviewed admitted patients to obtain medical information, weight and height measurements and vital signs.
  • Computer documentation of patient information obtained from interviews.
  •  Successful primary patient care, case management and medication management.
  • Assessed patients and documented their medical histories.
  • Evaluated patient care needs, prioritized treatment, and maintained patient flow.
  • Extensive knowledge of  various medical conditions including, but not limited to Parkinson's, Dementia, Diabetes, Cancer, Alzheimer's and Paget's disease.
  • Collected blood, tissue and other laboratory specimens and prepared them for lab testing.
  • Extensive ability to do vitals/glucose testing and assisted in administering injections and urinalysis.
  • Skillfully performed suture removals for patients of all ages.
  • Skillfully performed suture removals for patients of all ages.
  • Implemented necessary changes based on evaluation of staffing requirements and floor assignments.
  • Successfully  provided patient education on discharged to home.
Float Nurse, Register Nurse, 07/2004 - 06/2009
Jenny Edmondson Hospital City, STATE,
  • Interviewed patients to obtain medical information, weight and height measurements and vital signs.
  • Interviewed patients to obtain medical information, weight and height measurements and vital signs.
  • Documented patient information obtained from interviews.
  • Performed basic physical assessments of newborns and infants.
  • Administered medications and assisted in diagnostic testing for all medical patients.
  • Responsible for primary care, case management, and medication management.
  • Assessed patients and documented their medical histories.
  • Evaluated patient care needs, prioritized treatment, and maintained patient flow.
  • Evaluated patient care needs, prioritized treatment, and maintained patient flow.
  • Trained new staff on quality control procedures.
  • Experience with various medical conditions including, but not limited to Parkinson's, Dementia, Diabetes, Cancer, Alzheimer's and Paget's disease.
  • Assisted doctors with surgeries and non-invasive procedures.
  • Authorized drug refills and provided detailed prescription information to pharmacies.
  • Collected blood, tissue and other laboratory specimens and prepared them for lab testing.
  • Performed vitals/glucose testing and assisted in administering injections and urinalysis.
  • Performed vitals/glucose testing and assisted in administering injections and urinalysis.
  • Skillfully performed suture removals for patients of all ages.
  • Implemented necessary changes based on evaluation of staffing requirements and floor assignments.
  • Demonstrated ability to lead and motivate outstanding healthcare teams.
  • Contributed substantially to successful department JCAHO accreditation.
  • Provided patient education.
  • Ordered and read lab tests, x-rays, MRIs, Ultrasounds, and EKGs.
  • Treated patients with strokes, head traumas, comas, and intracranial hematomas.
  • Treated patients with strokes, head traumas, comas, and intracranial hematomas.
  • Treated patients with strokes, head traumas, comas, and intracranial hematomas.
  • Provided behavioral/emotional support in a mental health area  for those with mental illness, dementia and Alzheimer's.
Education
Bachelor of Science: Registered Nurse, Expected in
-
College of St M ary - Omaha, NE
GPA:
Status -

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Resume Overview

School Attended

  • College of St M ary

Job Titles Held:

  • Registered Nurse Redetermination Auditor
  • Registered Nurse
  • Float Nurse, Register Nurse

Degrees

  • Bachelor of Science

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