Joyce Testerman Email & Phone Number

o Responsible for coordinating all RAC correspondence by utilizing Milliman Care Guidelines and InterQual Level of Care Criteria. Responsible for coordination of appeals related to any denials received. o Preserves the integrity of the RAC database through detailed financial and clinical reporting.o Responsible for coordinating all Kepro and Strategic Health Solution correspondences through the utilization of Milliman Care Guidelines and InterQual Level of Care Criteria, to include the management of appeals related to corresponding denials. o Coordination of retro-authorizations for traditional Medicaid and Medicare denials.

o Executed case management activities, to include: pre-certification, utilization review, recertification and discharge planning. o Utilized Milliman Care Guidelines to determine appropriate level of care and medical necessity. o Responsible for coordination of appeals for denials. o Work closely with Medical Director regarding case management and utilization review activities, denials/appeals/peer to peer reviews. Responsible for coordination of appeals for denials. o Responsible for communication of all medical decisions and ensuring completion within the Tennessee Insurance Commission.

Bristol, Tn

o Maintained multiple computer applications, including HHS, HSM, HMR, EPW and Admin RX. o Performed system analysis, documentation, testing, implementation, and user support for new software releases.o Provided after-hours support for applications and project efforts as needed. o Performed upgrades, patches, hot-fixes, and testing prior to application of change in a live environment.o Followed internal procedures for change management, incident management, and escalation. Consulted McKesson to correct issues that required greater analysis and testing. o Managed reports required for HSM.

Bristol, Tn

o Responsible for the execution of direct patient care, to include the maintenance of IV integrity, medicating patients prior to bedside procedures, and their transfer to the operating room.

Bristol, Tn

o Performed chart audits and utilization review activities. o Demonstrated knowledge of endoscopic procedures and expertise in use of pertinent equipment.o Administered conscious sedation and monitored patient during endoscopies and other minor procedureso Prepared for procedures as appropriate and operated instruments, supplies, and equipment in a manner that is cost effective without compromising quality of care.o Conducted and documented a thorough assessment of each patient's medical status upon admission and throughout the patient's course of treatment.o Responsible for charging of supplies and supply ordering.

Abingdon, Va

o Ensured that facility operations and patient care was delivered in an efficient manner by coordinating all staff and patient schedules, to include all vacation requests, call coverage, and the coordination of patient visits with case managers. o Coached new hires on facility operations and on the process of laptop documentation related to patient care. o Maintained contact with physician offices to coordinate collateral patient care by maintaining lab orders and agency referrals.o Responsible for the coordination of admission and discharge procedures for all incoming and existing clients and oversaw the issuance of certifications based on admission assessments. o Responsible for obtaining insurance verifications and visit approvals, conducted chart reviews and utilization reviews, and coordinated all case management activities. o Coordinated in-service training sessions for new product roll-outs and required annual training material.

o Responsible for the coordination of admission and discharge procedures for all incoming and existing clients and oversaw the issuance of certifications based on admission assessments. o Coordinated the patient visit schedule with nursing staff and conducted outside patient referrals. o Performed chart reviews and audited information listed, conducted utilization review, and coordinated all case management activities. o Obtained labs as directed by the physicians and reported on acute problems that may occur with each individual patient.

Bristol, Tn

o Responsible for the execution of direct patient care, to include the maintenance of IV’s and cardiovascular drips, pacer wires, mediastinal tubes and associated insertion sites. o Supported physicians with direct patient care procedures.

Abingdon, Va

Responsible for the execution of direct patient care, to include the maintenance of critical drips, mixing and administering of patient medications and the maintenance of patients IV’s and ventilator settings.

Bachelor Of Nursing

Associate Degree Of Nursing And Applied Science

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