Andrea Landtroop
Charleston,SC
Overview
25
25
years of professional experience
Work History
Review Coordinator, CMS, BFCC-QIO
Livanta, LLC
07.2024 - Current
- Interprets and applies coverage and payment policies and standards of care.
- Conducts all mandatory case review and quality assurance activities as stipulated by contract(s) and maintains required timeliness and accuracy within the review process.
- Maintains responsibility for assuring an efficient case review process through the production system, and identifies and corrects problem areas on both a case-by-case and system-wide basis.
- Edits text for dissemination in documents handed off to other medical personnel responsible for making phone contact with beneficiaries and providers.
- Informs beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.
- Acts as a neutral liaison for beneficiaries and/or their representatives.
- Informs Medicare beneficiaries, healthcare providers, and other partners, of the activities and responsibilities of the Quality Improvement Organization.
- Collaborates with internal and external QIO staff on development and implementation of healthcare improvement projects.
Lead Medical Review Specialist, CMS CERT
Empower AI
09.2022 - 05.2024
- Supervises approximately 8-10 Medical Review Specialists.
- Completes third level Medical Review in determinations of claims when first and second level medical reviewers are in opposition.
- Performs comprehensive medical record and claims review to make payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare Part A and Hospice.
- Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
- Utilizes Microsoft Office suite and other software templates as associated source input for claims review.
- Makes clinical judgment decisions based on clinical experience when applicable.
- Managed a high volume of reviews within tight deadlines, ensuring timely completion and client satisfaction.
Medical Review Specialist, CMS CERT
Empower AI
04.2010 - 09.2022
- Performed comprehensive medical record and claims review to make payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare Part A including Hospice.
- Performed first and second level of Medical Review in determination of claims payment review
- Conducted in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
- Utilized electronic health information imaging and input medical review decisions by electronic database module.
- Made clinical judgment decisions based on clinical experience when applicable.
- Ensured departmental compliance with quality managements system and ISO requirements.
First Lieutenant
US Army Nurse Corps, Reserves
04.2011 - 05.2017
- Served Soldiers and their Families as a Medical/Surgical Nurse.
- Remained ready to provide care and support for humanitarian missions such as natural disasters or conflicts abroad.
Case Manager (Contract)
Virginia Premier Health Plan, Inc.
09.2009 - 04.2010
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
Home Health Supervisor
Care Advantage
09.2008 - 01.2009
- Collaborated with CMS and Kepro (Quality Improvement Organization) regarding Medicaid members.
- Managed team of home health nurses and aides, ensuring efficient allocation of resources and timely service delivery.
- Conducted home visits to ensure staff were complying with care plans and providing exceptional treatment.
- Developed individualized patient care plans.
Registered Nurse, Surgical Oncology/Hospice IPU
Henrico Doctors' Hospital
09.2007 - 09.2008
- Managed patients recovering from medical or surgical procedures.
- Administered medications, blood transfusions and chemotherapy to Oncology patients.
- Assumed charge nurse responsibilities and was preceptor to new staff members.
- Managed pain effectively by closely monitoring symptoms and adjusting medications accordingly.
- Conducted comprehensive assessments of patients'' conditions to determine appropriate care plan interventions.
Registered Nurse, Medical-Surgical Unit (Contract)
Retreat Doctors' Hospital
01.2007 - 09.2007
- Provided exceptional care to medical-surgical patients including pain management, education and post operative treatments.
- Served as a preceptor for new staff.
- Performed charge nurse duties and management of staff.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Registered Nurse, Postpartum/Nursery
St. Francis Medical Center
08.2005 - 01.2007
- Administered medications.
- Provided education on topics of self care, newborn and breastfeeding.
- Performed vital signs checks and administered vaccinations to infants following birth.
- Conducted comprehensive physical assessments and assisted with pain management.
Forensic Nurse Examiner
St. Mary's Hospital
02.2004 - 11.2005
- Conducted comprehensive medical evaluations to determine the extent of injuries sustained during traumatic events.
- Assisted law enforcement in investigations by accurately interpreting injuries related to criminal activities or suspicious circumstances.
- Provided expert witness testimonies in court proceedings.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Registered Nurse
Head Start Child Development Center
01.2001 - 08.2003
- Provided oversight and care to approximately 500 children (ages 3-5) in 8 Head Start child development centers across Long Island, NY.
- Conducted health screenings to Head Start participants including well child checks, vaccinations, hearing, vision, blood pressure, oral and lead screenings..
Registered Nurse, Medical/Surgical/Orthopedic
Huntington Hospital
08.1999 - 01.2001
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Conducted thorough patient assessments to identify changes in condition.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
Education
Bachelor of Science - Nursing
Adelphi University
Garden City, NY05.1999
Timeline
Review Coordinator, CMS, BFCC-QIO
Livanta, LLC
07.2024 - Current
Lead Medical Review Specialist, CMS CERT
Empower AI
09.2022 - 05.2024
First Lieutenant
US Army Nurse Corps, Reserves
04.2011 - 05.2017
Medical Review Specialist, CMS CERT
Empower AI
04.2010 - 09.2022
Case Manager (Contract)
Virginia Premier Health Plan, Inc.
09.2009 - 04.2010
Home Health Supervisor
Care Advantage
09.2008 - 01.2009
Registered Nurse, Surgical Oncology/Hospice IPU
Henrico Doctors' Hospital
09.2007 - 09.2008
Registered Nurse, Medical-Surgical Unit (Contract)
Retreat Doctors' Hospital
01.2007 - 09.2007
Registered Nurse, Postpartum/Nursery
St. Francis Medical Center
08.2005 - 01.2007
Forensic Nurse Examiner
St. Mary's Hospital
02.2004 - 11.2005
Registered Nurse
Head Start Child Development Center
01.2001 - 08.2003
Registered Nurse, Medical/Surgical/Orthopedic
Huntington Hospital
08.1999 - 01.2001
Bachelor of Science - Nursing
Adelphi University