Verified accuracy of claims prior to submission for payment ensuring compliance with payer requirements.
Responded promptly to inquiries from internal customers regarding correct application of codes.
Conducted research on various coding topics as needed.
RN, BSN
Danville Dermatology
Danville
12.2010 - Current
Managed complex cases involving multiple diagnoses or treatments.
Assisted physicians with medical treatments and examinations of patients.
Collaborated with other health professionals in order to provide comprehensive care for patients with complex issues related to their skin.
Maintained accurate patient records including documenting examination results, medications prescribed, and follow-up instructions.
RN, BSN- HEDIS Review Nurse
Centene
Remote
12.2022 - 05.2023
Assessed accuracy of coding by performing retrospective review of members' medical records.
Created reports on HEDIS scores, findings, and recommendations for corrective action plans.
Assisted with the development, implementation, and maintenance of audit processes related to HEDIS measures.
RN,BSN-Hedis Nurse
Change Healthcare
Remote
12.2017 - 05.2019
Researched industry standards related to health plan performance metrics.
Maintained comprehensive database tracking all actions taken in relation to quality improvement initiatives.
RN - Labor and Delivery
Lake Cumberland Regional Hospital
Somerset
12.2012 - 08.2014
Managed multiple tasks efficiently while providing quality patient care in a fast paced environment.
Responded promptly to call lights and bells or requests from patients or family members regarding their needs or concerns.
Ensured that all necessary equipment was available prior to start of labor process.
RN, BSN
Russell County Hospital
Russell Springs
12.2010 - 12.2012
Provided emotional support to patients and families by listening to their concerns.
Maintained a safe environment for patients by adhering to established policies and procedures regarding medication administration and infection control practices.
Documented patient care services by charting in electronic records system in accordance with guidelines.
Assessed patients for signs and symptoms of medical conditions and reported changes to physicians.