Bailey Sisk, Mba, Bsn, Rn, Ccs Email & Phone Number

San Diego, CA, US

Reno, NV, US

Newtown Square, Pennsylvania, US

• Performed comprehensive reviews of inpatient medical records to validate MS and APR DRGs assigned for Medicare, commercial, and third-party paid claims.
• Validated that all ICD-10-CM/PCS codes, discharge dispositions, Hospital Acquired Conditions (HAC), medical necessity, and Present on Admission (POA) indicators impacting payment are documented, clinically supported.
• Reviewed denial letter rationales and formulated compelling appeal response letters supported with current industry clinical guidelines, evidence-based medicine, and official coding guidelines. Successful at.
• Additional experience performing Quality Assurance (QA), peer mentoring, denials management, and providing client education for identification of risk areas and to improve payer contract negotiations.
• Rules architect: formulated and implemented underpayment and overpayment rules based on auditor findings and denials to efficiently and effectively target audit case selection.
• Successfully completed auditor training and currently preparing for CDIP certification with expectation of completion by mid-2023.

San Diego, California, US

• Screened, coordinated, and facilitated direct admissions and transfers into Scripps acute facilities. Ensured delivery of optimal service while promoting fiscal responsibility.
• Ensured the daily operations, procedures, and standards of care are maintained in accordance with hospital and regulatory guidelines.
• Utilizing critical thinking, interpersonal and technical skills, provided a high level of clinical assessment of patients to ensure placement in the appropriate level of care with required services.
• Facilitated appropriate level of care using InterQual criteria to ensure quality care to maximize reimbursement.
• Evaluated available resources, planned, and implemented necessary services and monitored outcomes.
• Expert understanding of financial reimbursements and third-party payments.

• Subcontractor for Anthem. Developed auditor training for MS DRG and APR DRG claims targeting concepts.
• Created rules to identify DRG overpayments and analyzed existing rules for opportunities to refine and improve recovery return on investment.
• Developed clinical and coding-based education for recovery auditors for new rule strategies and to improve hit rates with existing strategies.
• Subcontractor for Gorman Health Group. Administrative assistant in the R1 RCM revenue cycle management analysis project.
• Coauthor of an online risk adjustment training program and national certification test for Medical Management Institute.

Temecula, California, US

• Cared for wide range of body systems specializing in neurosurgical, post-operative, cardiothoracic, and pulmonary conditions.
• Experienced with high acuity patients; including but not limited to, ventilators, craniotomy, ventriculostomy, Impella, open heart patients (CABG), pulmonary artery catheters, multiple organ failure, and intra-aortic.
• Teaching hospital with experience leading daily interdisciplinary rounds and building rapport with physicians, pharmacists, dietitians, and other hospital staff.

• Experienced with ventilators, titrating critical drips, central venous pressure monitoring, arterial lines, and pulmonary artery catheters.
• Cared for wide range of patient conditions including respiratory, cardiac, post-operative, oncology, neurology, and gastrointestinal illnesses.
• Experienced with Continuous Renal Replacement Therapy (CRRT)
• Leader of the code blue and rapid response team
• Leader of daily interdisciplinary rounds and communication with other care team members
• Floated to the Neuroscience Intensive Care Unit

• Cared for patients of all ages from newborn to end of life, including but not limited to; septic shock, renal failure, STEMI and NSTEMI, GI bleeds, post-operative, DKA, respiratory failure on continuous BIPAP, delirium.
• Successfully completed three-month critical care class and one-on-one preceptor training.
• Experienced with titrating cardiac, vasopressor, insulin, heparin, and sedative drips.
• Routinely cared for patients with chest tubes, arterial lines, tracheostomies, and long-term ventilators.
• Assisted with procedures including cardioversion, bronchoscopy, bedside tracheostomy, and intubation.
• Frequently floated to the Intensive Care Unit (ICU) and Cardiac Progressive Care Unit (CPU).

Bachelor Of Science In Nursing (Bsn), Registered Nursing/Registered Nurse

Master Of Business Administration - Mba, Concentration In Healthcare Administration