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Click here or scroll down to respond to this candidateJalessa Resume 2024Candidate's Name
Austin, TX,PHONE NUMBER AVAILABLEEMAIL AVAILABLESummary 9+ years in Nursing and Data Entry, 3+yrs of experience as Utilization Review Nurse and HEDIS Review/Abstractor Nurse. Microsoft Office Skills including Outlook, Excel, Teams, QSHR, Reveleer, Cotiviti, Rapid, M360,Cerner, Labcorp and Quest portals, MCG, Interqual, Clinical Repository, Adobe, KDJ Pillar, QMRM. Ability to type 50 WPM with accuracy of 98%.Education Temple College- Temple TX May 2015 Licensed vocational Nurse High School Diploma, Hendrickson High School- Pflugerville, TX Certifications and Licenses Licensed Practical NurseLVN #326964 Date Expires: 11/30/2024Skills LVN Inpatient Outpatient Case Management Benefits administration ICD-9/ ICD-10 Medical Records Nurse Management Insurance Verification CPT Coding Medical Office Experience Health coaching Medication review Medical documentation Supervising Experience Cerner Medical Billing EMR Systems Utilization review Charts Abstractions Pharmacy ScriptProfessional ExperienceCommunity Health choice / MedixJan 2024- June 2024HEDIS Over reader I (Contract) Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff. Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through an over-read process, including a re-review of charts that may contain similar errors. Identify and report abstraction errors and provide measure re- education for the abstractor.Accenture/ Adecco- Austin, TXRemote Enrollment Representative - State of MassAug 2023-Dec 2023. Demonstrated understanding of insurance carrier administrative processes and procedures, with experience serving as an advocate for clients. Processing enrollments and dis-enrollments of state and marketplace carriers. Assisting with billing and payment processing.Anthem/Lance Soft Inc. - Austin, TX,Jan 2023 to May 2023Remote- HEDIS Abstractor/ HEDIS Review Nurse Collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database. Required to perform research on internal claims systems. Responsible for retrieval, review, and abstraction of medical record data, required for a non-complex sub-set of STARS and HEDIS measures as well as entering the data into a quality program tool. Care Link - Austin, TX2022 to Jan 2023Utilization Review Nurse PRN (Remote) Collaborate with providers by reviewing the level of care appropriateness. Provide summary of clinical and ancillary information to designated clinics and the appropriate medical staff member for review and decision making. Research and identify information needed to perform assessments (e.g., navigate through resources, clinical data, and databases such like Milliman and Interqual).Centene - Austin, TX - contract2021 to 2022Remote- Utilization Nurse Initiated out of network authorization requests for Medicaid, Medicare, and commercial insurance. Collaborate with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity. Prioritizing and allocating time to effectively achieve project deliverables Abstract medical records through multiple databases. Worked on special projects Comply with all HIPAA compliance rules including Privacy, Security and Breach Adhere to State and federal guidelines Proficient in Microsoft Office: Outlook, Excel, and Word, Teams, Outbound and inbound fax systems and similar applications efficient in Interqual, MCG.Other ExperienceCantex Continuing Care Network - Round Rock,TX2019 to 2020Staffing Coordinator- Management Prepare "monthly" schedules for all nursing departments Maintain a list of open positions via Company job postings Perform initial interview of staff Complete reference checks; licensure/ certification verification and Employee Misconduct Registry on potential new hires prior to employment of individual Perform Orientation for staffing personnel Report to DON/designee daily of staffing patterns and/ or open positions Maintain accurate phone list of nursing personnel Handle all staffing calls while on duty M-F Perform initial disciplinary action for staffing issues Community Care - Austin, TX2017 to May 2019LVN Clinic Nurse Made outbound calls to patients to complete telephonic interventions and education for the management of their health, wellness and chronic conditions. Educate patient on medication administration, case management for chronic diseases Complete referrals, prior authorizations as well as help coordinating patients with outside sources to help with economic hardships. Medical record review before previous visit. Medical record abstract Immunized patients ranging pediatrics to geriatrics Wesleyan Homes - Georgetown,TX 2015 to 2017Charge Nurse Administers basic nursing care to Residents in accordance with facility's policies and procedures. Thoroughly assesses Residents and responds according to Nursing Standards of Practice. Plans and implements Resident care according to Care Plan. Performing health assessments and monitoring in-patients. Maintaining and updating patient records.Baylor Scott and White - Round Rock,TX May 2015 to Apr 2016Clinic Nurse Performs assigned nursing duties, including assessing, planning, implementing and evaluating patient care, under the direct supervision of an RN/Physician. Maintaining and updating patient records. Collecting information and samples for diagnosis. Pro Lab Incorporated - Austin,TX Jan 2013 to Apr 2015Phlebotomist Primarily responsible for the timely and correct collection of Specimens requested by ProLab clients. Identifying patients via ID, medical record or other means. Drawing blood using needles and other equipment. Labeling samples correctly and send them for testing. |
