Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Generic

Amy Chamberlin

Endwell,NY

Summary

Adaptable professional with a quick-learning ability and a talent for adjusting to new environments. Skilled in rapidly acquiring new knowledge and applying it effectively. Driven by a passion for continuous learning and successfully navigating change. Highly motivated with a strong work ethic, skilled in working under pressure and looking to take on a new challenge.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Nurse Care Manager/Clinical Denials Specialist

United Health Services Hospitals
Johnson City, NY
06.2019 - Current
  • Coordinated with other departments to ensure efficient workflow processes.
  • Developed instructional resources for onboarding staff on procedures and guidelines
  • Participated in ongoing training and compliance activities.
  • Cultivated positive working relationships with both colleagues and supervisors
  • Pinpointed improvement areas, streamlining focus for decision-making processes.
  • Reviewed claims against set insurance standards to verify qualification for reimbursement
  • Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
  • Monitored denial process for inconsistencies in medical records
  • Created solutions to address intricate denial problems
  • Maintained communication with providers regarding denied claims and appeals processes.
  • Conducted research on payer policies to ensure compliance with industry standards.
  • Engaged in collaborative sessions with medical professionals on mitigating denials
  • Evaluated accounts for potential appeal opportunities
  • Employed critical thinking to assess denial trends
  • Prepared and submitted appeal letters and necessary documentation to overturn unjustified denials.
  • Ensured compliance with healthcare regulations and insurance policies during the denial management process.
  • Analyzed claim denials data to report on patterns and performance metrics to management.
  • Reviewed and analyzed denied claims to determine reasons for denial and identified corrective actions.
  • Monitored trends in claim denials to identify opportunities for process improvement and training.
  • Investigated complex denials to pinpoint causes and devise effective appeal methods.
  • Collaborated with healthcare providers and insurance companies to gather additional information and resubmit denied claims.
  • Participated in regular training sessions to stay updated on changes in healthcare regulations and insurance policies.
  • Attended educational conferences in order to stay abreast of changes in the field of nursing.
  • Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
  • Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
  • Referred cases to secondary review for failure to meet criteria.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Maintained up-to-date knowledge of changes in healthcare regulations, policies, and evidence-based practices.

Nurse Care Manager (ED and Unit Based)

United Health Services Hospitals
Johnson City, NY
12.2014 - 06.2019
  • Provided education to patients on self-management of chronic conditions.
  • Conducted patient assessments and identified health risks.
  • Coordinated with physicians, nurses, and other healthcare providers to ensure continuity of care.
  • Monitored and evaluated patient outcomes in order to improve quality of care.
  • Streamlined assignment of necessary follow-up care services post-patient discharge
  • Partnered with interdisciplinary teams to streamline patient transitions.
  • Arranged collaborative sessions to strategize on complex patient care solutions.
  • Identified potential barriers that may impact a patient's ability to comply with prescribed medical regimens.
  • Supported difficult decision processes concerning final stages of life
  • Communicated concerns to supervising physicians based on patient behavior assessments
  • Liaised with interdisciplinary team to address patient needs
  • Performed concurrent reviews of medical records during active episodes of care.
  • Monitored patient admissions and discharges to optimize care coordination and resource utilization.

GI Lab Nurse

United Health Services Hospitals
Johnson City, NY
08.2008 - 12.2014
  • Assessed and monitored patient health conditions, including vital signs such as temperature, pulse rate and blood pressure.
  • Administered medications and treatments in accordance with physician orders.
  • Assisted physician with examinations, tests and procedures.
  • Monitored patients after surgery, answered questions, and provided home care strategies.
  • Trained and mentored new RNs on best practices, hospital policies and standards of care.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.

Staff Nurse, Med/Surg/Telemetry

United Health Services Hospitals
Johnson City, NY
06.2003 - 08.2008
  • Maintained accurate records of patient progress notes, medications administered and other relevant data.
  • Demonstrated effective communication skills while interacting with patients, families, physicians and other healthcare staff members.
  • Provided direct patient care including wound dressing, administering medication and IV therapy.
  • Collaborated with interdisciplinary team members to develop plans of care for patients.
  • Addressed rapid response and code situations by strategically organizing and delegating tasks.
  • Educated nursing students on proper care procedures and prioritization strategies.

Education

Bachelor of Science - Nursing

Elmira College
Elmira, NY
05-2005

Some College (No Degree) - Mechanical Engineering

Binghamton University
Binghamton, NY

Some College (No Degree) - Pharmacy

Massachusetts College of Pharmacy
Boston, MA

Skills

  • Clinical Decision-Making
  • Clinical Assessment Skills
  • Care Coordination
  • Clinical Documentation
  • Appeals processing
  • Critical Thinking
  • Case Management
  • Analytical Skills
  • Effective Interpersonal Communication
  • Medical Records Review

Certification

  • NYS Registered Professional Nurse License #563956
  • Certified Care Manager (Inactive status)

Accomplishments

  • Recently featured in an article on Becker's ASC Review, published 8/29/2024: What ASCs can do after claim denials (beckersasc.com)

Timeline

Nurse Care Manager/Clinical Denials Specialist

United Health Services Hospitals
06.2019 - Current

Nurse Care Manager (ED and Unit Based)

United Health Services Hospitals
12.2014 - 06.2019

GI Lab Nurse

United Health Services Hospitals
08.2008 - 12.2014

Staff Nurse, Med/Surg/Telemetry

United Health Services Hospitals
06.2003 - 08.2008

Bachelor of Science - Nursing

Elmira College

Some College (No Degree) - Mechanical Engineering

Binghamton University

Some College (No Degree) - Pharmacy

Massachusetts College of Pharmacy

Similar Profiles

CREATE PROFILE
Amy Chamberlin