AMBER WALDEN
Tompkinsville,KY
Summary
Leveraged expertise in OASIS, Homecare Homebase, and EMR systems to foster interdisciplinary collaboration and uphold regulatory compliance in clinical documentation improvement.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Assistant Director of Nursing
Signature Healthcare of Monroe
Tompkinsville, KY
07.2025 - Current
- Led nursing staff in implementing patient care protocols, enhancing overall care quality.
- Collaborated with interdisciplinary teams to optimize healthcare strategies and improve patient outcomes.
- Developed training programs for nursing staff, increasing competency and ensuring compliance with regulations.
- Streamlined communication processes between departments, enhancing operational efficiency and teamwork.
- Conducted performance evaluations, providing guidance and support to nursing staff for professional growth.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Performed rounds to observe care and interview staff, residents, and families.
- Collaborated with interdisciplinary teams to develop efficient care strategies tailored to individual patient needs.
Medical Review Nurse
Performant Healthcare Solutions
01.2022 - 07.2025
- Executed independent audits of over 100 Medicare claims weekly to ensure compliance with CMS policies.
- Evaluated clinical documentation to ensure accuracy in medical necessity coding (ICD-10, CPT, HCPCS) and compliance with billing regulations.
- Compiled comprehensive audit reports referencing CMS Chapter 8/15 and MAC policies with precision.
- Facilitated collaboration with providers to address discrepancies and enhance appeal success rates.
- Monitored regulatory changes impacting Medicare audits and refined review processes accordingly.
- Evaluated areas of DME, SNF, drugs, and biologic medications for compliance and effectiveness.
- Facilitated remote collaboration and communication among team members.
Home Health Nurse
Amedisys Home Health
01.2017 - 01.2022
- Formulated Oasis-compliant care plans utilizing Homecare Homebase PDGM to ensure precise ICD-10 coding alignment with clinical documentation.
- Facilitated training sessions on CMS home health regulations to enhance team compliance standards.
Obstetric Nurse/Clinical Manager
Women and Children's Clinic
01.2002 - 01.2016
- Directed daily clinic operations and managed staff scheduling.
- Oversaw and guided nursing staff and clinical teams to ensure optimal patient care.
- Facilitated collaboration with OB/GYN providers to optimize patient flow.
- Addressed patient concerns and escalated issues to ensure timely resolution.
- Trained new employees on company procedures and policies. Assisted current staff in enhancing their skills and knowledge. Supported ongoing professional development initiatives.
- Oversaw clinic performance metrics and implemented quality improvement initiatives.
- Collaborated with billing staff to enhance accuracy of documentation processes.
- Oversaw surgical scheduling and directed pre-certification processes.
Education
Associate's Degree in Nursing (ADN) - undefined
Western Kentucky University
Skills
- Conducted thorough evaluations and audits of medical claims to ensure compliance with Medicare CMS standards
- Oversaw compliance initiatives for icd-10 and hcpcs coding within the organization Led training programs to enhance team knowledge of coding regulations Collaborated with departments to ensure adherence to coding standards and best practices
- Oversaw documentation processes for Oasis and Homecare Homebase to enhance operational efficiency Coordinated with teams to streamline record-keeping and compliance efforts Led initiatives to improve homecare documentation practices
- Oversaw the integration of smartbin technology to enhance waste collection efficiency Coordinated with cross-functional teams to optimize operational workflows Championed initiatives to improve sustainability practices within waste management
- Managed denial management and appeals to uphold compliance and enhance operational efficiency
- Monitored and maintained compliance with CMS Medicaid regulations to support operational integrity
- Oversaw implementation of electronic medical records systems to improve data accessibility Collaborated with healthcare professionals to optimize patient information management Championed initiatives to enhance EMR usage across departments
- Leveraged remote work proficiency to enhance team productivity and maintain project timelines
- Oversaw the integration of Microsoft Office applications to enhance team productivity Facilitated effective communication and collaboration through Outlook management Developed comprehensive reports and presentations in PowerPoint to support strategic initiatives
- Oversaw implementation of EMR systems, including Homecare Homebase and Mars/Smartbins, to enhance operational efficiency Led training sessions for staff on system usage and best practices Fostered collaboration among teams to optimize data management processes
- Oversaw the implementation of audit tools to evaluate NCDs and LCDs Led initiatives to ensure adherence to CMS Chapter 8 standards Managed UPIC activities to strengthen regulatory compliance
Certification
- Compact RN License (Multi-state)
- CPT/HCPCS Coding Familiarity (Optional): willing to pursue Certified Professional Coder (CPC)
Timeline
Assistant Director of Nursing
Signature Healthcare of Monroe
07.2025 - Current
Medical Review Nurse
Performant Healthcare Solutions
01.2022 - 07.2025
Home Health Nurse
Amedisys Home Health
01.2017 - 01.2022
Obstetric Nurse/Clinical Manager
Women and Children's Clinic
01.2002 - 01.2016
Associate's Degree in Nursing (ADN) - undefined
Western Kentucky University