Amy Viccora
Fairfax,VA
Summary
Accomplished Registered Nurse/Clinical Auditor at MedStar Georgetown University Hospital, adept in leveraging critical thinking and attention to detail to mitigate financial risks through effective appeal processes. Demonstrated success in overturning denials and recovering associated claims through succinct, clear written appeals.
Overview
32
32
years of professional experience
Work History
Clinical Auditor
MedStar Georgetown University Hospital
01.2012 - Current
- Prepare and summarize appeals using medical information for payer review.
- Monitor appeal determinations including payment for overturned denials.
- Combine clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided.
- Collaborate with physicians, Utilization Review RN's, Case Managers, revenue cycle personnel and payers to appeal denials.
- Educates process physicians and hospital staff to address issues that impact the number and type of denials. Serves as a resource to all staff in areas of utilization review/management.
Clinical Research Nurse Coordinator
Inova Health Systems Fairfax Hospital
05.2002 - 12.2011
- Screened, consented and enrolled subjects into research trials while adhering to Good Clinical Practices and FDA regulations.
- Administered investigational medications and performed patient assessments during clinic visits to determine the presence of side effects; notifies treating investigator of findings/issues.
- Managed budgets and resources effectively, enabling successful completion of multiple concurrent clinical trials within allocated funding constraints.
- Provided patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment
Telephonic Nurse Case Manager
Oxford Health Plans
01.1997 - 05.1999
- Determined medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
- Identified member needs on discharge in collaboration with facility
- Facilitated timely referrals to appropriate specialists, expediting necessary treatments and improving overall health outcomes.
- Managed caseloads efficiently while prioritizing urgent cases requiring immediate intervention.
- Identify member needs on discharge in collaboration with facility
Staff RN
Bridgeport Hospital
06.1992 - 12.1994
- Provided complete care for medical cardiology patients
- Monitored vital signs, lab results, and other indicators to detect changes in patients'' conditions promptly.
- Coordinated discharge planning in collaboration with case managers, social workers, and other support staff for optimal continuity of care after hospitalization.
- Implemented appropriate interventions based on assessment findings to maintain or improve patients'' health status.
Education
Bachelor of Science - Medical Rehabilitation
Springfield College
Springfield, MAPost-Baccalaureate Diploma - Nursing
Bridgeport Hospital School of Nursing
Bridgeport, CTSkills
- Team collaboration
- Decision-making
Attention to detail
- Critical thinking
- Clear concise writing skills
Accomplishments
- Overturn approximately minimum of $250,000 in denied funds annually.
- Successfully appealed an account filed with Maryland Insurance Administration.
- Worked with MGUH legal to recover approximately $750,000 in related inappropriately denied claims issued by Maryland Medicaid Managed insurer.
- Interim Director of Case Management.
- Nurse of the Month, MedStar Georgetown University Hospital 2014.
Nurse of the Year Case Management Department 2014
Selected by case management department and hospital administration.
Timeline
Clinical Auditor
MedStar Georgetown University Hospital
01.2012 - Current
Clinical Research Nurse Coordinator
Inova Health Systems Fairfax Hospital
05.2002 - 12.2011
Telephonic Nurse Case Manager
Oxford Health Plans
01.1997 - 05.1999
Staff RN
Bridgeport Hospital
06.1992 - 12.1994
Bachelor of Science - Medical Rehabilitation
Springfield College
Post-Baccalaureate Diploma - Nursing
Bridgeport Hospital School of Nursing
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