Supervised a team of 18 employees while continuing to act as principal trainer for new hire on-boarding, both in-person and remote. Primary point of contact for staff questions, assistance and continued education. Leadership duties included facilitating daily and weekly team meetings, approval of account adjustments, communicating process changes, inventory management and backlog planning, quality assurance (QA) and productivity monitoring, participation in performance reviews, Epic resolute… Show more Supervised a team of 18 employees while continuing to act as principal trainer for new hire on-boarding, both in-person and remote. Primary point of contact for staff questions, assistance and continued education. Leadership duties included facilitating daily and weekly team meetings, approval of account adjustments, communicating process changes, inventory management and backlog planning, quality assurance (QA) and productivity monitoring, participation in performance reviews, Epic resolute hospital billing workflow optimization and overall process improvement feedback, and encouraging remote staff participation and engagement. Show less

Assessed inpatient and outpatient claim denials for all payer types. Denial reasons included medical necessity, lack of or incomplete authorization, readmission and experimental/investigational. Prepared clinical appeals as needed utilizing appropriate guidelines (MCG, InterQual, NCD/LCD, FDA guidelines).

Assessed each patient for discharge needs and executed discharge plan accordingly. Independently arranged home healthcare, home infusions and durable medical equipment including ambulatory aids, respiratory supplies and wound VACs. Made referrals to SNF, IPR and LTAC facilities as appropriate and coordinated patient’s transfer to those locations at discharge. Managed patient’s length-of-stay through collaboration with physicians and utilization review staff with additional focus on patients in… Show more Assessed each patient for discharge needs and executed discharge plan accordingly. Independently arranged home healthcare, home infusions and durable medical equipment including ambulatory aids, respiratory supplies and wound VACs. Made referrals to SNF, IPR and LTAC facilities as appropriate and coordinated patient’s transfer to those locations at discharge. Managed patient’s length-of-stay through collaboration with physicians and utilization review staff with additional focus on patients in observation status. Show less

I was a float case manager at MVH, and as such I gained case management experience in many different areas including cardiology, intensive care, orthopedics, neurology and surgical units. It was my responsibility to meet with each patient upon admission to determine potential discharge needs or barriers to follow up. On a given day I was responsible for anywhere from 24-36 patients depending on the unit I was assigned to at the time. We had ancillary staff that would make arrangements for home… Show more I was a float case manager at MVH, and as such I gained case management experience in many different areas including cardiology, intensive care, orthopedics, neurology and surgical units. It was my responsibility to meet with each patient upon admission to determine potential discharge needs or barriers to follow up. On a given day I was responsible for anywhere from 24-36 patients depending on the unit I was assigned to at the time. We had ancillary staff that would make arrangements for home health services or home medical equipment and it was my job to determine those needs and refer to the appropriate individuals to have those needs met. I'd also complete prior authorization requests, arrange for transportation and provide assistance to my social work partner to coordinate transfers to skilled nursing or inpatient rehabilitation facilities as needed. I also worked closely with the hospital physicians to try to manage patient length of stay and to coordinate discharge plans. Show less

I was an alternate Charge RN on 40-bed medical-surgical/pulmonary/detox unit. Our areas of specialty were COPD (we were a certified COPD unit) and drug and alcohol detoxification and withdrawal, but as a medical-surgical unit we also saw all the other varied diagnoses that fall into the med-surg category.

Patient Care Tech on a 40-bed surgical unit.