-Audit charts to determine if they meet IQ/MCG criteria.-Determine if cases are appropriate for appeal or if they need to be sent for rebill.-Determined what type of appeal was appropriate and prepared it for submission.-Coordinated efforts with CBO to have medical records and other documentation compiled for submission.

Developed and implemented the Authorization Coordinator role.-Collaborate with Insurance Verification, Insurance CM, Hospital Case Manager, UR/Transition planners and physicians to facilitate obtaining authorizations.- Work to prevent denials by coordinating Peer to Peer conversations, sending Expedited Appeals or Reconsiderations as appropriate.- When pre-claim denials cannot be overturned, send chart for secondary review and submit medical records for appeals as deemed appropriate. - Trend disputes and denials to be reported to the Director of Case Management and the UR Committee- Collaborate with Patient Access, Case Management and Business Office to improve concurrent review process to avoid denials or processes that delay in billing accounts in a timely manner.- Manage the active list of appeals and keep status updated in Revenue Cycle.- Close appeals and send for adjustments as appropriate. - Collaborate with the Clinical Documentation Specialist as reviews show potential denials and am pro-active in responding to prevent the denial.- Provide pertinent denial criteria to physicians to assist in Peer-to-Peer conversations as well as to Utilization Review to assist with UR process.

- Manage/Coordinate the care of 20-30 patients at any given time.- Uses critical thinking skills to provide in-home assessments to determine if a patient is adjusting well at home, if they need an appointment with a PCP or if they need immediate/emergent attention. - Teach patients and their families to help them successfully adjust to being home after a hospitalization or time in rehab.- Create and effectively implement Plans of Care for each of my patients, changing/updating them as appropriate.- Work collaboratively with Doctors, Physical/Occupational/Speech Therapists as well as Home Health Aids, Social Work, other Case Managers and LVNs to make sure the patient is cared for on a holistic level, maintain an open line of communication throughout the process.- Prior to patient admit, reviewed the type of insurance coverage a patient had (Medicare, Medicaid, HMO or private insurance) to cover their home health services and informed them of any potential outlying cost.

- Provided direction to non-nursing staff, served as a preceptor. - Provided care by utilizing my critical thinking skills to provide continuous assessment to critically ill patients.- Consulted/Collaborated with other team members as required and provided nursing care that demonstrated patient centered care.

- Managed/coordinated the care of 20-40 patients at any given time.- Created and effectively implemented Plans of Care for each of my patients, changing/updating them as appropriate.- Worked collaboratively with Doctors, Physical/Occupational/Speech Therapists as well as Home Health Aids, Social Work, other Case Managers and LVNs to make sure the patient was cared for on a holistic level maintaining an open line of communication throughout the process.- Managed the On-Call Schedule for nursing staff. - Provided continuing education in-service presentations for nursing staff.

- Provided direction to non-nursing staff, served as a preceptor, and had training to be a Charge Nurse.- Provided care by providing continuous assessment to critically ill patients.- Consulted/Collaborated with other team members as required and provided nursing care that demonstrated patient centered care. - Learned to exercise independent judgment in providing nursing care and how to take initiative in recommending changes to care plan.- Learned to communicate effectively with patients, families, and hospital staff.

- Provided direction to non-nursing staff, served as a preceptor, and had training to be a Charge Nurse.- Provided care by providing continuous assessment to critically ill patients.- Consulted/Collaborated with other team members as required and provided nursing care that demonstrated patient centered care. - Learned to exercise independent judgment in providing nursing care and how to take initiative in recommending changes to care plan.- Learned to communicate effectively with patients, families, and hospital staff.