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Skills

  • Claims adjudication
  • Fluent in Japanese
  • Oxygen saturation standards
  • HIPAA compliance
  • Chronic disease management
  • Insulin medication assistance
  • Patient Satisfaction Score Improvement
  • Patient care coordination
  • Women's health exams
  • Patient case escalation

Work Experiences

  • Maintained quality standards by conducting routine medication audits and adhering to internal and industry best practices.
  • Provided critical-ill patients with a skilled, timely, and level-headed emergency response.
  • Medication and IV administration, catheter insertion, and airway management were among the interventions I implemented.
  • Adhered to continuous clinical education and utilized advanced practice certification to assist in reducing the medical claims backlog by 24%.
  • Assessed appropriateness of treatments.
  • Oversaw 11 nurses and nursing activities in a 14-bed hospital, providing comprehensive nursing guidance and ensuring high levels of patient satisfaction and care.
  • Prepared blood, tissue, and other laboratory specimens for testing in the lab.
  • Achieved 3 successful appeals.
  • Achieved a 71% reduction in liability cases.
  • Observed and reported on the patient's condition, progress, and medication side effects to accurately document updates.

Summaries

  • Achieved over 8 successful appeals.
  • With strong attention to detail, clinical expertise, and emergency response experience, she is adaptable and resilient.
  • Leader who prioritizes quality and efficiency.
  • Professionally trained with quality assurance and stakeholder engagement abilities.
  • Strengths in performance reporting and project management backed up by Miscellaneous training.
  • Proven leader with a track record of successfully uniting and guiding nursing teams toward patient care goals, increased satisfaction, and the continuous implementation of widespread healthcare system initiatives.
  • Analytical Nurse Reviewer experienced in collaborating with physicians and UR teams to decrease unnecessary admissions by 78% while maintaining high safety standards in process.
  • Expert in all aspects of patient care, with a track record of success in collaborating with multidisciplinary teams to develop care plans aimed at assisting patients in recovering from medical or surgical procedures as well as managing complex mental illnesses.
  • With expert healthcare knowledge, clear verbal and written communication skills, and sound clinical judgment, this person is team-oriented and dependable.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.

Accomplishments

  • Guided nursing teams in utilizing metric for chart reviews, enhancing data accuracy by 29% during two years.
  • Traveled to 6 regional care facilities performing educational sessions on the benefits of thorough medical documentation and its impact on insurance claims processing.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Analyzed clinical case reports to guide disease management reviews, assisting in the resolution of 3 complex cases per category.
  • Spearheaded a quality improvement project focused on chronic disease reviews, increasing outcomes for high-risk patients by 66%.
  • Collaborated with a cross-functional team and conducted peer reviews to improve throughput on high-priority claims by 4 per month.
  • Led internal educational sessions to improve peer-to-peer medical chart reviews, decreasing the rate of contested claims by 78%.
  • Worked with key stakeholders to ensure adherence to initiative requirements, consistently meeting/exceeding compliance audits with a 18% approval rating.
  • Reduced grievance-related delays by implementing a collaborative review system that decreased patient complaints by 68%.
  • Reviewed treatment plans and made appropriate case referrals, increasing review speed and decision accuracy by 28%.

Affiliations

  • American Marketing Association
  • American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)
  • Society of Women Engineers
  • Certified Case Manager (CCM) Designation
  • Society of Gastroenterology Nurses and Associates (SGNA)
  • International Association of Administrative Professionals
  • National Transitions of Care Coalition (NTOCC)
  • American Health Information Management Association (AHIMA)
  • Association for Computing Machinery
  • Freemason

Certifications

  • Certified HIPAA Professional (CHP)
  • Certified Professional in Patient Safety (CPPS)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Apple Certified Associate (ACA)
  • First Aid/CPR Certified
  • Certified Clinical Research Professional (CCRP)
  • Certified Nurse Life Care Planner (CNLCP)
  • Certified Case Management Administrator (CCMA)
  • Accredited Case Manager (ACM)
  • CompTIA Network+

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