Alisha Williams

• Provided patient education on disease prevention, health maintenance, and the management of chronic conditions.
• Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
• Participated in continuing education and professional development opportunities to stay current with advances in nursing practice.
• Utilized evidence-based practice guidelines for assessment, diagnosis and treatment planning decisions.
• Performed physical exams, ordering and evaluating lab test as well as medications.
• Built trust and rapport with patients by listening to concerns, advocating for wellness and educating on acute and chronic health issues.

• Remains knowledgeable in CPT and ICD-10 coding principles, government regulations, and third-party billing rules.
• Applies the correct InterQual criteria and medical necessity based on clinical information.
• Maintains a working knowledge of the appeal processes and requirements of payers.
• Maintains responsibility and accountability for the communication of clinical information required by the payer post-discharge in case of denials.
• Works collaboratively with physicians, other team members, the client's payers, and administrations.
• Participate in Accounts Receivable Reconciliation Group (ARG) calls with our non-contracted payers, administrative hearings for Managed Medicaid claims, and Administrative Law Judge (ALJ) hearings for Medicare claims after internal appeals have been exhausted.

• Provide general medical care and care coordination for adults, pediatrics, and geriatrics in a variety of settings, including home, skilled nursing facilities, and public locations.
• Perform comprehensive evaluations, including history and physicals for gaps in care and preventative assessments.
• Address both chronic and acute primary care complaints.
• Create and implement a medical plan of care.
• Provide post-discharge coordination to reduce hospital readmission and emergency room utilization.
• Completed diabetic metrics, e.g., A1c, retina Vue exams, KED kits.
• Completed coaching sessions with team members who required additional assistance with meeting productivity metrics and performance goals.
• Train new hires, and complete chart reviews on all team members on my team to ensure quality documentation, and provide education where needed.
• Lead biweekly team meetings.

• Maintained a strong knowledge of medical terminology, diseases, conditions, and procedures.
• Communicated with healthcare staff, including physicians, nurses, and other caregivers, to explain the importance of accurate and clear documentation.
• Questioned physicians regarding missing or unclear health record documentation and required further information for clarification purposes.
• Carefully reviewed patient files for clarity on diseases, diagnoses, and procedures to determine quality of care.
• Reviewed charts and flagged incomplete or inaccurate information.
• Led the department committee meetings and worked closely with the leadership team to implement quality initiatives.
• Developed physician query templates to be utilized by the CDS team to ensure ICD-10 compliance.

Marked with different disciplines to provide cohesive care to patients.

Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.

Educated patients and loved ones about different treatment options and outside care approaches, reducing the burden on hospital resources.

• Cultivated warm and compassionate atomosphere for patients receiving chemptherpay on the unit.
• Counseled patients and provided listening ear and emotional support
• Educated patients on such topics as nutrition, medication side effects, and proper skin treatments after radiation.
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
• Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols to optimize performance and safety.
• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
• Monitored patient reactions and administering medications and IV therapies.
• Monitored patient reactions after administering medications and IV therapies
• Managed patients recovering from medical or surgical procedures, including facilitating wound care, ostomy care, pressure ulcer prevention, and pain management.
• Implemented interventions and educated and answered questions about health condition, prognosis, and treatment.