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Home: PHONE NUMBER AVAILABLE Cell: PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFESSIONAL SUMMARYMedical Surgical RN with more than twenty five as a manager/leader. Over thirty two years as a registered nurse with experience with both pediatric and adult population. Skilled to work in a clinic, hospital, school environment and claims reconciliation.PROFESSIONAL EXPIERENCEMEDICAL REVIEW SVC NURSE 04/12/2016 to presentCONDUENT- Ridgeland, MSReviewed CMS/1500 and UB04 Claims for proper billing and coding.Reviewed H&P, OP Notes, Discharge summaries for medical necessityPrepared correspondence to Providers (MD, NP, OD, PA)Prepared Claims for reviewed by MS MEDICAID STAFFProcessed claims to be paid or denied.QUALITY ASSURANCE MANAGER 07/2014 to 04/2016CHOICES FOR CHILDREN AND FAMILY HEALTHCARE Jackson, MSPerformed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.Developed and maintained quality care systems and standards, including but not limited to, creating and improving medical protocols/guidelines.Sound, ethical and independent decision-making ability consistent with medical protocols.MEDICAL REVIEW NURSE 11/2012 to 07/2014INFORMATION and QUALITY HEALTHCARE Jackson, MSPerformed Medicare discharge appeals for Home Health, Hospice, Hospital and SNFWrote Correspondence based on CMS guidelines.Provided a quick response to Medicare Providers according to CMS standards.Served as liaison between Patient and Providers.Provided minimal billing knowledge to Mississippi Providers.EPSDT REVIEW NURSE 01/2003 to 11/2012Mississippi Division of Medicaid Jackson, MSConducted Medical Reviews on EPSDT Medicaid ProvidersEvaluated program performance against expectations, and directed an improvement plan.Coordinated and project meetings.Monitored claims for paid and denied status.Performed on-site and technical assistance on new enrolled Medicaid Provider.PREVENTATIVE HEALTH SCHOOL NURSE COORDINATOR 01/2002 to 01/2003University of Mississippi Medical Center Jackson, MSMonitored RNS in the school setting, and provided TA according to Medicaid protocolManaged operations in accordance with budget requirements, and directed improvement plansEvaluated program performance against expectations.MEDICAID PROGRAM NURSE 01/2001 to 01/2002Mississippi Division of Medicaid Jackson, MSWrote Medicaid policy and procedures.Contacted providers to discuss rebilling and reimbursementCoordinated Quality Improvement Activities to identify performance areas for improvement.Served as a liaison between patients and physicians.Provided necessary health education to patients and provided TA to Medicaid Providers.NURSING DIRECTOR 08/1989 to 01/2001Jackson Hinds Comprehensive Health Center Jackson, MSServed as liaison between management, clinical staff and the community.Cooperated with other health related agencies and organizations in community activities.Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.Provided supervision for day-to-day operations of facility in accordance with set policies and guidelines.Regularly evaluated employee performance, provided feedback and assisted, coachedCHARGE NURSE/STAFF NURSE 08/1997 to 08/1998Vicksburg Medical Center Jackson, MSAssigned teams and team assignments.Administered medications and assisted in diagnostic testingEvaluated patient care needs, prioritized treatment and maintained patient flow.Accurately documented all elements of nursing assessment, treatments, medications, dischargeplans and follow-up care.Utilized strong assessment skills to determine necessary patient care.UNIT FACILITATOR COORDINATOR/CHARGE NUSES 01/1986 to 08/1989Mississippi Baptist Hospital Jackson, MSOriented new nurses to MED-Surgical Unit.Assist as staff nurse, took vital, skilled nursing.Served as charge nurse, assigned teams and team assignments.Developed and maintained quality care systems and standards, including but not limited to, creating and improving medical protocols/guidelines.EDUCATION AND TRAININGBachelor of Science: Nursing, May 2002Mississippi College Clinton, MSAssociates of Applied Science: Nursing, May 1985Hinds Community College Raymond, MSSKILLSEPSDT Biller, CMS Standards and Policy, McKessons software, Good Oral Communication, CPR,Excellent Leadership Skills, Microsoft Office (Excel, PowerPoint, Microsoft Word). |
