Insurance Analyst Resume Profile

Summary

Certified, experienced, compassionate, organized hospice and palliative care Registered Nurse Case Manager. Specializing in providing in-home and facility care to terminally ill patients and their families. Well versed in current changes in Medicare regulations and recertification documentation. excellent interpersonal and communication skills. Certifications: CPR, CHPN, Intravenous Therapy, Massage therapy and level II Reiki practitioner. Experienced in staff management with excellent computer skills, in both PC and MAC systems, familiar with electronic medical records EMR , excellent communication and interpersonal skills.

Experience

Confidential

Registered Nurse Case Manager

Collaborates with the healthcare team, patient and patient's family, and helps direct the work of the healthcare team to provide care that is continuous and well coordinated.
Regularly re-evaluation patient's needs and assessment of data to determine care plan needs with facilities and families.
Responsible for evaluating patients for determination if qualified for hospice care under Medicare guidelines. Responsible for pronouncing deceased patients, discharging and completing death certification in EDRS.
Assisted living, skilled/long term care and acute settings.
Responsible for completing initial assessment of patient and family to determine care needs in
Supervision, orientation and training of CHHA's on an ongoing basis to ensure compliance with plan of care, documentation requirements.
Responsible for preforming periodic and annual performance evaluations for CHHA's
Initiating and communicating appropriate interventions while providing support and guidance to patient and family.
Communicates with the physician regarding the patient's needs and reports any changes in the patient's condition and obtain orders.

Confidential

Registered Nurse Case Manager

Responsible for assessing, planning and delegating patient care for in-home care team
Identify physical, psychological, social and spiritual needs of the patient and their families.
Educated patients and their families regarding hospice, end of life care and symptom management.
Supervised and provided ongoing education with HHA's to ensure compliance with plan of care and documentation requirements, preformed annual evaluations.
Acted as liaison between patient and family, physician, and interdisciplinary team.
Responsible for initiating and communicating appropriate interventions while providing support and guidance to patient and family.
Continuously provided appropriate, comprehensive intuitive plan of care through documentation regarding patient care while supporting continuity of care as required by Medicare regulations.
Reviewed and maintained accurate medication records.

Confidential

Registered Nurse Telemetry Unit

Responsible for providing exceptional care for patients and their families.
Coordinated with Physicians, ICU, Medical Surgical, Emergency, and Social Services departments to ensure continuity and quality of care as patients passed through the hospital system.
Monitored and interpreted cardiac rhythms to ensure appropriate care.

Confidential

Insurance Analyst

Responsible for conducting Medicare Fair Hearings utilizing all collected evidence and documentation.
Worked closely with Compliance Department to insure correct submission and adjust claims non- compliant with Medicare regulations.
Assisted in coordinating the department to bring it in compliance with HIPPA regulations.
Completed the Medicare credit balance report on a quarterly basis.

Confidential

Medicare Biller

Reviewed Medicare Explanation of Benefits, corrected and resubmitted claims through FSS.
Worked with Compliance Department to insure correct submission and adjust claims non-compliant with Medicare regulations.

Confidential

Project Coordinator

Worked closely with the director of marketing to expand customer base.
Set up and managed a staff of six for front end collections for medical accounts.

Confidential

Insurance Specialist

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