Amber Dees, RN

• Analyzed Medical records and applied annotations for multiple complex Diseases for approval or denial of claims.
• Provided written communication to the Attorney of Record and/or claimant by Notification of status letter. Managed all written communications from the Disease Claims Department.
• Managed and performed telephone communication with Attorney of Record and/or claimant outlining deficiencies in claims and provided information on how to cure the deficiencies for claim approval.
• Assisted Quality Management with Disease claims submitted for Appeal.
• Chronologies for challenging claims.
• Directly supervised team of up to 15 employees in the Disease Claims Review Department. Performed quality reviews, monitored productivity, and provided feedback and coaching.
• Provided one-on-one training and mentoring to all team members.
• Coordinated and managed various programs and projects to achieve established objectives and deadlines.
• Participated in ongoing training and compliance activities.
• Coordinated with other departments to ensure efficient workflow processes.
• Exercised versatility in fast-paced, agile work environments.
• Performed Claims assistance via telephone and Data Entry.

Pre-Admitting/Ambulatory Care

• Developed Policies and Procedures for the Pre-Admitting Department.
• Performed pre-operative assessments prior to scheduled surgeries or procedures including phlebotomy, EKGs, and scheduling of anesthesia assessments.
• Reviewed and notified physicians of abnormalities prior to scheduled procedure.
• Assessed and monitored patient health, vital signs, and symptoms to identify any changes in condition.
• Performed physical assessments of ambulatory patients post-operative to assess current medical status.
• Assisted Radiologist with special procedures and Quality Management Department as needed.
• Maintained accurate documentation of patient encounters according to facility standards.
• Attended weekly interdisciplinary meetings to discuss individual cases and develop treatment plans.
• Administered medications prescribed by physicians in accordance with hospital policy.
• Managed multiple cases simultaneously while demonstrating excellent time management skills.

Charge Nurse Medical-Surgical/Orthopedic Unit

• Provided direct patient care, including assessments and treatments, to a variety of patients. Coordinated and performed patient admissions, transfers and discharges.
• Conducted daily rounds to assess patient conditions, evaluate progress towards goals, and document changes in status or plan of care as needed.
• Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
• Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
• Coordinated communication between physicians and other healthcare professionals regarding patient care.
• Educated patients, caregivers and families on diagnoses, treatment and disease prevention.
• Provided emotional support for families facing difficult decisions regarding end-of-life care.
• Delegated tasks appropriately among staff members according to their qualifications.
• Trained and mentored new RNs on best practices, hospital policies and standards of care.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.