Amy Russo
Charlotte,North Carolina
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
14
14
years of professional experience
Work History
Divisional Compliance Advisor
Blue Cross NC
Durham, NC
04.2022 - Current
- Review and update compliance policies, procedures and standards to ensure adherence to Centers for Medicare and Medicaid Services regulations.
- Develop and implement strategies to strengthen the organization's compliance program.
- Provide guidance on regulatory requirements and identified potential areas of non-compliance.
- Conduct risk assessments, gap analysis, root cause analysis and other activities to identify areas of improvement in the organization's compliance processes.
- Monitor organizational activities through internal audit process for compliance with applicable mandates and regulations.
- Prepared reports for executive management regarding risks, audit results, trends in non-compliance areas.
- Facilitate communication between departments within the organization regarding changes in relevant mandates and regulations.
- Coordinate and lead meetings and training with internal teams on new processes and requirements.
Episodic Care Manager
Blue Cross NC
Durham, NC
09.2013 - 04.2022
- Coordinated with other health care providers, such as physicians and psychiatrists, to develop comprehensive treatment plans.
- Maintained accurate records of client visits and progress notes in accordance with agency policies and procedures.
- Served as a subject matter expert within the Care Management department, providing assistance to peers and other department personnel in regards to work processes and procedures
- Provided excellent nursing based customer service to members and providers
- Researched current standards of care to contrast with all available medical necessity guidelines across a broad spectrum of specialties to ensure the most positive outcome for patients
- Participated in special projects, aid Team Leaders in identifying issues and contribute in the development of new processes and departmental guidelines
Utilization Review Nurse
Novant Health, Inc
Matthews, NC
09.2010 - 09.2013
- Maintained utilization review logs as needed and created reviews to send to insurance companies
- Analyzed patient medical records to ensure documentation compliancy with Government and private insurance company reimbursement policies
- Coordinated peer to peer reviews when required by patients attending physicians
- Presented and explained government issued notice of coverage benefit information to patient
Education
Licensed Practical Nurse - Nursing
East Brunswick Adult Vocational And Technical
East Brunswick, NJ03-1993
Skills
- Audit management
- Policy analysis
- Corporate Governance
- Documentation Review
- Compliance Monitoring
- Risk Management
- Training delivery
- Deficiency documentation
- Regulations enforcement
- Reporting Requirements
- Project Coordination
- Internal Audits
- Schedule Management
- Diversity and Inclusion
- Outstanding customer service
- Coaching and Mentoring
- Complaint resolution
- Workplace Safety
- Employee engagement
- Time Management
- Multitasking
- Event Planning and Coordination
Affiliations
- Board President, Common Heart
- Elder, Threshold Church
- Event Coordinator, Threshold Church
- Volunteer, South Charlotte Dog Rescue
Timeline
Divisional Compliance Advisor
Blue Cross NC
04.2022 - Current
Episodic Care Manager
Blue Cross NC
09.2013 - 04.2022
Utilization Review Nurse
Novant Health, Inc
09.2010 - 09.2013
Licensed Practical Nurse - Nursing
East Brunswick Adult Vocational And Technical