- Crystal , MN
- [email protected]
• Nursing experience with all medical specialties. Greater then 8 years in Managed Care working predominantly with Medicaid and Medicare with an emphasis in behavioral/mental health and chemical dependency programs, and over 5 years experience in OB/GYN including implementation and role out of one Minnesota’s first online prenatal medical record.
• Medical Review and analysis of medial records with a keen ability to quickly identify and distinguish between appropriate and inappropriate documentation and use of CPT coding.
5/2007-Current Position involved but is not limited to the review of medical documentation against criteria requirement for the purposes of determining coverage of select services for medical necessity, and approval of coverage when criteria is met. Claims adjustments, provider education, provider grievance resolution along with the use of multiple computer systems, and ongoing education of Medicare and Medicaid criteria are all integral parts of my employment.
8/2010-4/2012 Promoted to temporary position involving case management of the restricted recipient members and their assigned providers with special consideration to complex mental health needs of this chemically dependent population. Responsibilities include working with the Department of Human Services to supervise members who have inappropriately utilized their medial benefits. Position also involved review of claims and program regulations via the Department of Human Services and Minnesota Health Plan policies and procedures.
• Recruited from staffing agency to continue supporting EpicCare. Responsibilities Included analysis, design, support and Implementation of EpicCare order entry system to ensure productive use by end users. Although this position was intriguing, budget constraints for further technical training and certification prompted me to seek employment elsewhere.
Hired to assist Health Partners with their transitional phase to Electronic medical records. Training on-site medical staff to utilize EpicCare with charting, billing and system communications. Additionally required to assist physicians, providers and nursing staff at all clinic locations with patients and procedures. This position has allowed me to work with all different medical specialties, including working in conjunction with a multitude of language translators due to our diverse patient populations. I have enjoyed this temporary assignment and accepted a position with Health Partners to continue supporting EpicCare.
Subcontracted to perform independent case review and analysis. Responsibilities included review of medical records and submission of a written summary and analysis of pertinent medical findings. This process required but was not limited to determine medical necessity and relevance to surgical and medical intervention resulting in subsequent effective patient care and treatment. This position allowed my nursing skills to be utilized in a completely different manner from traditional nursing thus helping to broaden my knowledge base within the ever expanding medical and legal nursing field. I will hold my experience with PetersonReed as an invaluable experience and will continue to miss the opportunities and challenges of which this position offered me.
**Partnership dissolved in 2008**
Position entailed contacting on-site medical chart review for external audit in accordance with the NCQA. Chart audit and submission of copies of any significant findings to inquiring health plans- A submission of daily data reports and e-mail communications with the Hedis, Denver (new location as of 2013 in Plainfield, IN)office was also required. Strong organizational skills along with excellent phone and computer skills assured that my assignments were completed within their allotted time frames. These projects were annual based and have helped to expand my knowledge of Insurance and HMO accountability. Audit reviews also helped advance my technical nursing skills. Due to outstanding efficiency on my assignments I have been selected as a Minnesota representative for Q-Mark Hedisheip, but due to full-time employment opportunities I did not accept the 2005, 2006 or 2007 audit position.
Initial job placement following graduation from Hennepin Technical College Employed as a staff Licensed Practical Nurse. Primary role was to provide direct assistance to clinic OB/GYN physicians. Responsibilities included the following: completion of patient history, patient education, and preparations of rooms for procedures and medical procedures, and administration of injections. Also responsible for scheduling surgeries, medical procedures, phone triage and preparing patient charts for provider review. I thoroughly enjoyed this position, but left on good terms due to a difficult pregnancy.
(6/1996-8/1998] Hennepin Technical College Brooklyn Park, MN
Licensed Practical Nurse
• Diploma in Licensed Practical Nursing
• GPA 3.82
(8/2009-Current) North Hennepin Community College Brooklyn Park, MN
Currently enrolled in the RN Mobility Program half-time at North Hennepin Community College; to be completed in 2014.
Phi Theta Kappa Member active since 2009
Co-Owner of PetersonReed Certified Legal Nurse Consultants
Direct Supervisor at Health Partners
Direct Supervisor at UCare
Co-Worker at UCare