Amber Sable
Ankeny,IA
Summary
Seasoned nursing professional offering proven clinical knowledge, interpersonal strengths, and technical abilities. Knowledgeable about utilization review and payment policy analysis, as well as interdisciplinary collaboration focused on optimizing patient outcomes. Quality focused and efficiency driven team player.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Payment Policy Analyst-Clinical
WELLMARK BCBS OF IOWA AND SOUTH DAKOTA
01.2022 - Current
- Developed, implemented, researched, analyzed, maintained documentation for payment policies.
- Examined provider payment claim reports daily, maintaining accuracy and efficiency per payment policies.
- Coordinate with payment vendor to refine the claims handling system.
- Supported Wellmark in meeting its benefit savings objectives.
- Partner with provider community, Payment Integrity team, Medical Directors, and other stakeholders at Wellmark to develop payment policies.
- Achieved title of Certified Professional Coder.
Utilization Management
WELLMARK BCBS OF IOWA AND SOUTH DAKOTA
01.2017 - 01.2022
- Streamlined hospital and clinical service approvals by aligning decisions with medical policies and necessary clinical data.
- Collaborated with Wellmark Medical Director, physician consultants, and appropriate vendor representatives.
- Conducted prior approval pre-service reviews and determinations for continued stay assessments.
- Efficiently managed utilization requests by leveraging clinical knowledge to interpret medical policies, InterQual criteria, and benefit details for customers.
- Engaged with Wellmark Medical Director to address discrepancies in medical criteria for levels of care.
- Ensured accurate diagnosis codes for documentation purposes through professional interaction.
- Engaged in open, direct communication with providers to address utilization review issues.
- Managed utilization review process effectively.
- Addressed main obstacles to patient discharge.
- Collaborated with various internal and external stakeholders to meet member needs effectively.
- Consistently met established benchmarks for utilization management's quality assurance and productivity.
- Accurately document events within CCMS by adhering to standard work guidelines and policies.
- Delivered approval and denial notifications to members and providers through verbal and written communication.
- Documented denials accurately.
- Ensured compliance with relevant standards for Utilization Management Services.
RN- Surgical Department
UNITY POINT HEALTH
01.1999 - 01.2017
- Enhanced surgery outcomes through effective teamwork in cardiothoracic operations.
- Demonstrated cross-functional expertise ensuring comprehensive support to various medical departments.
- Applied organizational skills and attention to detail for efficient multitasking.
RN- Wellness department
UNITY POINT HEALTH
01.1999 - 01.2017
- Executed thorough employee health screenings encompassing various diagnostic procedures.
Education
Bachelor of Science - Nursing
Allen College
Waterloo, IA01.2018
Associate Degree - Nursing
Lake Land College
Mattoon, IL01.1998
Skills
- Excel
- Microsoft Word
- Encoder
- Cotivity Claims Inquiry Tool
- Optum Claims Editing System
- Facets
License
Iowa State Board of Nursing License, 100564
Certification
Certified Professional Coder
Timeline
Payment Policy Analyst-Clinical
WELLMARK BCBS OF IOWA AND SOUTH DAKOTA
01.2022 - Current
Utilization Management
WELLMARK BCBS OF IOWA AND SOUTH DAKOTA
01.2017 - 01.2022
RN- Surgical Department
UNITY POINT HEALTH
01.1999 - 01.2017
RN- Wellness department
UNITY POINT HEALTH
01.1999 - 01.2017
Bachelor of Science - Nursing
Allen College
Associate Degree - Nursing
Lake Land College
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