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Skills

  • Patient and family advocacy
  • Collecting vitals
  • Chronic disease management
  • Insurance claim resolution
  • Acute care expertise
  • Tracheostomy care
  • High-volume case management
  • Denial management and appeals experience
  • Oxygen saturation standards
  • Healthcare workflow process improvement

Work Experiences

  • Achieved 58% more trial participants in 2024.
  • Led a successful 14-person team of registered nurses, licensed practical nurses, and ancillary staff.
  • Analyzed patient data to forecast the impact of pre-certification decision delays, helping to implement corrective action plans that reduced potential treatment delays by 38%.
  • Addressed delays caused by pre-certification errors.
  • Prepared blood, tissue, and other laboratory specimens for testing in the lab.
  • Oversaw nursing activities for 10 departments at a 2-bed hospital with 5+ employees, advising nurses on how to provide excellent patient care and satisfaction.
  • Administered various therapies and medications in accordance with physician orders and treatment plans.
  • Gave medications and treatments to patients and tracked their responses while collaborating with healthcare teams to adjust treatment plans.
  • Provided patient education and answered questions about their health, prognosis, and treatment options.
  • Collaborated with multidisciplinary teams to ensure the timely approval of pre-certifications, reducing care delays by 74% for patients in process.

Summaries

  • Leader who prioritizes quality and efficiency.
  • Achieved approval rates above 22% for high-cost treatments.
  • Experienced nurse with demonstrated clinical knowledge, natural interpersonal skills, and technical abilities.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Registered Nurse, North Carolina Board-Certified, with 5 years of experience providing high-quality care to patients in program and procedure care units.
  • Achieved approval rates above 76%.
  • Pre-Certification Nurse with a passion for health screenings and treating patients with system and program diseases.
  • Flexible and adaptable to changing patient needs and conditions.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved a 50% approval rate increase.

Accomplishments

  • Coordinated the resolution of discrepancies in payer approvals, recovering $175,000 in delayed reimbursements.
  • Collaborated with the billing department to recover $17 in lost revenue from rejected claims due to pre-certification issues.
  • Partnered with clinical teams to prioritize urgent pre-certification cases for system, ensuring timely patient care.
  • Utilized SAP system to track real-time approval status, reducing miscommunication with insurers and growing claims approval by 39%.
  • Monitored pre-certification submissions to remain 75% in compliance with local regulations and payer contract requirements.
  • Conducted follow-ups with insurance providers to resolve complex pre-certification issues, obtaining approvals in 61% of cases.
  • Resolved product issue through consumer testing.
  • Collaborated with team of 12 in the development of framework.
  • Supported patient access by enhancing communication between providers and payers, leading to 20% faster pre-authorization approvals.
  • Improved revenue cycle management by reducing pre-certification reworks, leading to a $68,000 increase in monthly collections.

Affiliations

  • Utilization Review Accreditation Commission (URAC)
  • National Association of Social Workers
  • International Association of Administrative Professionals
  • Association for Computing Machinery
  • Toastmasters
  • American Medical Informatics Association
  • National Association for Healthcare Quality (NAHQ)
  • Oncology Nursing Society (ONS)
  • Revenue Cycle Optimization Conference Speaker 2023
  • Certified Legal Nurse Consultant (CLNC) Six Sigma

Certifications

  • Certified Precertification Specialist (CPS)
  • Advanced Cardiovascular Life Support (ACLS) Certification
  • Certified Managed Care Professional (CMCP)
  • Certified Healthcare Access Associate (CHAA)
  • Certified Nurse Case Manager (CNCM)
  • Lean Six Sigma Green Belt Certification
  • Apple Certified Associate (ACA)
  • Certified Case Manager (CCM)
  • Certified Managed Care Nurse (CMCN)
  • Certified in Healthcare Compliance (CHC)

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