SUMMARY OF QUALIFICATIONS * Bachelor's degree in nursing with 18 plus years of varied nursing and administrative experience * Ensured appropriate client care by working with insurance, medical, and other providers to achieve compliance within regulatory guidelines * Reviewed prescriptions and physician orders for appropriateness and obtained clarification as needed * Performed medical record audits to ensure appropriate patient care was provided in accordance with physician orders and standard treatment guidelines * Prepared and presented training, audit information, patient progress and status, and budget information in various venues to program stakeholders * Reviewed medical and billing records to ensure appropriate diagnoses and treatment * Analyzed complex case records in order to provide technical assistance to other personnel and/or oversight agencies * Proven ability to manage nurses, aides, social workers, and administrative staff * Proficiency with oral and written communication * Obtain necessary documentation to ensure appropriate patient care and desired outcomes * Facilitated Interdisciplinary Team meetings Department of Labor (Office of Worker's Compensation Divisions of Energy Employee's Occupational Compensation Program (DEEOIC)) Nurse Consultant 08/2013 - 09/2016 Supported staff by performing medical record reviews and summaries disease process and standards of medical care (e.g. medications medical equipment and modifications) education and assisting with billing issues and requests for medical opinions for causation. Assisted Home Health Care (HHC) Claims' Examiners to identify appropriate documentation to support new requests or renewals for HHC. Identified instances where HHC companies had purchased supplies/equipment for claimants and billed DEEOIC at double or triple the original cost and worked with fiscal to affect billing changes. Affected policy change resulting in cost savings by identifying that some HHC companies were providing physical speech and occupational therapists and assistants without a physician prescription or program review or approval. Assisted claimant's by providing case status updates and explanations of received correspondence billing and payment issues.

Highlights:

• Medical
• Patient Care
• Security
• Policies and Procedures
• Budgeting
• Business Development
• Compliance
• Customer Service
• Billing
• Compensation
• Record Review
• MS Office