Alaya Stove
Houston,Texas
Summary
Compassionate Nurse Extern known for high productivity and efficient task completion. Possess specialized skills in patient care management, medical terminology fluency, and emergency response preparedness. Excel in communication, empathy, and teamwork to enhance patient experiences and support healthcare team objectives. Organized student nurse with passion for patients. Offers extensive hands-on experience in multiple units. Currently completing nursing studies and ready to expand practical knowledge. Compassionate Nurse Extern with strong track record in delivering patient-centered care. Adapt at performing accurate patient assessments and administering medication under supervision. Recognized for ability to educate patients on health management and delivering compassionate care. Significant impact made by reducing patient anxiety through effective communication and empathy.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Examiner
NTT Data
Houston, TX
03.2023 - Current
- NTT DATA - Remote Investigate claim issues, providing resolution within departmental and regulatory guidelines.
- Interprets and administers contract provisions: eligibility and duration.
- Accurately codes all system fields with correct financial, diagnosis, and duration information.
- Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work.
- Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
- Actively contributes to customer service, quality, and performance objectives.
- Proactively engages in departmental training to remain current with all claim management and AS practices.
- Responsible for managing Performance Guarantee clients and meeting targeted metrics.
- Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPAA rules and regulations.
- Participated in quality assurance activities, such as peer reviews and audits.
- Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, and Quality Assurance, as needed.
Claims Benefit Specialist
Broadpath Healthcare Solutions
Houma, LA
04.2021 - 04.2023
- Analyzes and approves routine claims that cannot be auto-adjudicated.
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis, and pre-coding requirements.
- May facilitate training when considered a topic subject matter expert.
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). - Utilizes all app.
- Negotiated settlement agreements between claimants and insurers on behalf of customers.
- Investigated potential fraud cases involving false claims submitted by customers.
- Verified customer eligibility for specific benefits according to established criteria.
- Developed training materials pertaining to proper procedures for handling benefit claims.
Nurse Aide
Terrebonne General Medical Center
Houma, LA
03.2021 - 03.2023
- Assisted with transferring patients from bed to wheelchair or stretcher.
- Maintained a clean environment by disinfecting equipment, emptying trash containers, cleaning surfaces, changing linens.
- Prepared meals for patients according to their dietary requirements.
- Organized activities that encourage socialization among residents in long-term care facility.
- Provided emotional support to patients and families during difficult times.
- Monitored patient's condition and reported any changes to the registered nurse or physician.
- Administered medications following established procedures and protocols under supervision of a Registered Nurse.
- Provided patient care, including bathing and dressing.
- Maintained patient confidentiality according to HIPAA guidelines at all times.
- Assisted nurses in providing medical treatments as directed by physicians.
- Documented information in patient charts and communicated status updates to interdisciplinary care team.
Patient Care Technician
7 Dawn
Dallas, TX
12.2019 - 01.2021
- Cleaning: Sanitizing and cleaning patients' rooms, changing bed linens, and providing new bedding.
- Monitoring: Measuring and recording vital signs, such as temperature, pulse, and blood pressure.
- Assisting with daily tasks: Helping patients with eating, dressing, bathing, and toileting.
- Performing nursing procedures: Administering medications, changing bandages, and checking temperatures.
- Collecting samples: Collecting urine, blood, and stool samples for testing and delivering them to the lab.
- Reporting: Reporting changes in a patient's condition to nurses or physicians, and receiving and reporting patients' concerns.
- Providing emotional support: Providing emotional support for patients and their families.
- Ensured that all medical equipment was properly maintained and sterilized.
- Organized supplies in order to maintain adequate stock levels throughout shift.
Education
Bachelor of Science -
Galen College of Nursing
Houston, TX06-2026
Associate of Science -
Baton Rouge College
Baton Rouge, LA04-2024
High School Diploma -
Terrebonne High School
Houma, LA05-2018
Skills
- Data Verification
- Investigative skills
- Claims Processing
- Microsoft Office Suite
- Policy Interpretation
- Verbal Communication
- HIPPA Regulations
- Data Collection
- Positive Reinforcement
- Learning techniques
- Skills Development
- Collaboration and Teamwork
- Adaptable nature
- Punctual
- Flexible working hours
- Learning environment structures
- Creative Thinking
- Treatment Planning
- Wound Care
- Electronic Charting
- Family Education
- Patient Assessment
- Injection Administration
- Catheter Care
- Vital signs monitoring
- Compassionate Care
- Feeding Assistance
- Medical Recordkeeping
- Documentation
- First Aid
- Active Listening
- Vitals monitoring
- Equipment Sterilization
- Multitasking
- Medication and IV administration
- Compassionate and Caring
- Blood Draw and Sample Collection
- ICD-10
- Accurate Documentation
Certification
- Medication Aide
Timeline
Claims Examiner
NTT Data
03.2023 - Current
Claims Benefit Specialist
Broadpath Healthcare Solutions
04.2021 - 04.2023
Nurse Aide
Terrebonne General Medical Center
03.2021 - 03.2023
Patient Care Technician
7 Dawn
12.2019 - 01.2021
Bachelor of Science -
Galen College of Nursing
Associate of Science -
Baton Rouge College
High School Diploma -
Terrebonne High School