Quality Assurance & Coding Specialist

• Feb 2022 - Present

Quality Assurance Registered Nurse

• Jul 2019 - Feb 2022

- Review clinical records to ensure compliance with agency policy, reimbursement requirements, maximization of utilization (frequency and disciplines) and good clinical standards of practice - Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards - Educate clinical staff on documentation requirements per agency policy and Medicare guidelines - Determine appropriate billing decisions regarding payer source upon admission and at recertification, monitoring for appropriate skilled need and supporting documentation - Review of documentation and follow up education with clinicians to ensure compliance with home care regulations, DPH standards, and best practice standards Show less

Regional Nurse Educator, Clinical Coding, and Oasis Review

• Oct 2018 - Jul 2019

- Provided education and technical support to all staff within the electronic medical record. - Developed standard processes for the home health business units in three states to ensure compliance with Medicare Conditions of Participation, best practice, company policy, and efficiency. - Assisted Virginia Home Health office in successfully passing CHAP certification. - Assisted Massachusetts Home Health office prepare for CHAP certification. - Review clinical records to ensure compliance with agency policy, reimbursement requirements, maximization of utilization (frequency and disciplines) and good clinical standards of practice - Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards - Educate clinical staff on documentation requirements per agency policy and Medicare guidelines - Determine appropriate billing decisions regarding payer source upon admission and at recertification, monitoring for appropriate skilled need and supporting documentation - Review of documentation and follow up education with clinicians to ensure compliance with home care regulations, DPH standards, and best practice standards Reason for leaving ~ Laid off due to operational changes Show less

Quality Assurance RN

• Jul 2018 - Oct 2018

- Review clinical records to ensure compliance with agency policy, reimbursement requirements, maximization of utilization (frequency and disciplines) and good clinical standards of practice - Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards - Educate clinical staff on documentation requirements per agency policy and Medicare guidelines - Determine appropriate billing decisions regarding payer source upon admission and at recertification, monitoring for appropriate skilled need and supporting documentation - Review of documentation and follow up education with clinicians to ensure compliance with home care regulations, DPH standards, and best practice standards Reason for leaving ~ The position was being eliminated due to a company merger. Other positions within the company were not of interest to me. Show less

Oasis Reviewer and Coder

• May 2018 - Jul 2018

- Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards. Reason for leaving ~ This was a temporary position until a permanent position could be obtained after being laid off. - Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards. Reason for leaving ~ This was a temporary position until a permanent position could be obtained after being laid off.

Quality Assurance and Education Nurse

• May 2016 - Apr 2018

· Improved agency STAR rating from 2.5 to 4.0 · Established agency Value Based Purchasing at 50% · Review clinical records to ensure compliance with agency policy, reimbursement requirements, maximization of utilization (frequency and disciplines) and good clinical standards of practice · Conduct continuous quality assurance and utilization review of clinical records per Medicare regulations/OASIS guidelines and best practice standards · Educate clinical staff on documentation requirements per agency policy and Medicare guidelines · Determine appropriate billing decisions regarding payer source upon admission and at recertification, monitoring for appropriate skilled need and supporting documentation · Review of documentation and follow up education with clinicians to ensure compliance with home care regulations, DPH standards, and best practice standards Reason for leaving ~ Quality Assurance department was laid off after company merger. Show less

Director of Clinical Services

• Feb 2016 - Apr 2016

- Supervise the day-to-day office and clinical operations - Approve weekly schedules and ensure productivity standards are met - Weekly case conferences with clinicians to review eligibility, best practice, and discharge planning - Educate clinical staff on documentation requirements per agency policy and Medicare guidelines - Educate staff regarding safe discharge planning for patients that do not meet insurance guidelines - Recruit, hire, and train field and office staff - Review and approve referrals per agency guidelines Reason for leaving ~ The company was unable to sustain operating costs Show less

RN Case Manager

• Jul 2010 - Feb 2016

-Case Management of the homebound patients -Perform initial and ongoing nursing assessment -Develop, evaluate, and implement plan of care with the patient, physician, and other disciplines -Timely and accurate documentation of daily visits -Weekly and as needed case conference with other disciplines -Participate in weekend and holiday rotation -Assist in orientation of new employees -Perform supervisory visits with home health aides and LPN’s Reason for leaving ~ An opportunity arose for management and I was ready to further my career. Show less

Assistant Director of Nursing/Nurse Practice Educator

• Apr 2013 - Apr 2014

-Provide nursing staff with clinical and educational support and guidance -Collaborate with clinical management to identify specific clinical educational needs -Round on units to observe/identify educational needs -Manage/coordinate all educational activities -Manage all infection control needs for the center -Track and ensure CPR certification up to date at all times -Assisted with successful conversion to electronic medical records Reason for leaving ~ My true passion is homecare. Show less

RN case manager

• Jan 2010 - Jul 2010

-Case management of homebound patients residing in assisted living communities -Perform initial and ongoing nursing assessment -Communication with assisted living staff, families, and medical providers -Develop, evaluate, and implement plan of care with the patient, physician, and other disciplines -Timely and accurate documentation of daily visits -Weekly and as needed case conference with other disciplines -Participate in weekend and holiday rotation -Assist in orientation of new employees -Perform supervisory visits with home health aides and LPN’S Reason for leaving ~ I was unable to fulfill the new on call requirements. Show less

RN case manager

• Jan 2006 - Jan 2010

-Case Management of homebound patients -Perform initial and ongoing nursing assessment -Communication with assisted living staff, families, and medical providers -Develop, evaluate, and implement plan of care with the patient, physician, and other disciplines -Timely and accurate documentation of daily visits -Weekly and as needed case conference with other disciplines -Participate in weekend and holiday rotation -Assist in orientation of new employees -Perform supervisory visits with home health aides and LPN’S Reason for leaving ~ New opportunity with better financial compensation. Show less

Co-Owner / Office Manager

• Jan 2002 - Feb 2006

Managed finances, scheduling, and record keeping Reason for leaving- Family decision to close the business Managed finances, scheduling, and record keeping Reason for leaving- Family decision to close the business

Staff RN

• Jan 2004 - Aug 2005

-Direct patient care including comprehensive nursing assessment, wound care, intravenous therapy, medication administration, etc -Provide education to patient and family regarding plan of care and disease process and management -Coordination of care with all disciplines and physicians Reason for leaving ~ new opportunity in homecare allowing a better work / home life balance. -Direct patient care including comprehensive nursing assessment, wound care, intravenous therapy, medication administration, etc -Provide education to patient and family regarding plan of care and disease process and management -Coordination of care with all disciplines and physicians Reason for leaving ~ new opportunity in homecare allowing a better work / home life balance.

Staff RN

• Aug 1999 - Jul 2003

-Direct patient care including comprehensive nursing assessment, wound care, intravenous therapy, medication administration, etc -Provide education to patient and family regarding plan of care and disease process and management -Coordination of care with all disciplines and physicians -Continuous telemetry monitoring and interpretation of rhythms -ACLS certified -Assist in orientation of new staff Reason for leaving ~ I took time off due to the birth of my child. Show less