Ann Howell

Acting as clinical resource, providing clinical review of claims to determine medical necessity of various types of provider and member claims.

• Assisted with training of new staff members on claims review process.
• Managed large volume of medical claims on daily basis, while meeting deadlines.
• Evaluated appeals filed by providers and members regarding denied or underpaid claims.
• Applied knowledge of healthcare regulations, laws, policies, procedures, guidelines and best practices when making decisions related to claims.
• Demonstrated excellent organizational skills by managing multiple projects simultaneously.
• Adhere to strict confidentiality requirements when handling sensitive information such as patient records or financial data.
• Skilled at working independently and collaboratively in team environment.
• Self-motivated, with strong sense of personal responsibility.
• Proven ability to learn quickly and adapt to new situations.
• Worked effectively in fast-paced environments.
• Demonstrated respect, friendliness and willingness to help wherever needed.
• Excellent communication skills, both verbal and written.
• Worked flexible hours across night, weekend and holiday shifts.

• Responded to patient emergencies to provide prompt and correct intervention.
• Administered medications and treatments to manage patient's condition.
• Demonstrated ability to perform basic nursing skills such as vital signs, medication administration and wound care.
• Assisted physicians with examinations and procedures in clinical environment.
• Demonstrated excellent time management techniques while managing multiple tasks simultaneously.
• Handled patient transfers, following safety protocols to prevent injuries.
• Educated staff members on new policies or procedures related to clinical operations.
• Served as clinical resource to staff, patients and families.
• Monitored clinical staff performance and provided feedback.

• Managed medication cart and dispensed pills, oral therapies and intramuscular injections to patients on Sub-Acute floor.
• Administered basic patient care and treatments by dressing wounds, treating bedsores, giving enemas and performing catheterizations.
• Administered medication such as insulin and monitored patients' responses to detect problems.
• Maintained accurate records of residents' healthcare treatments and responses.
• Administered oxygen therapy, aerosol therapy and inhalation therapy to improve patients' breathing and lung function.
• Performed bronchial hygiene techniques to remove mucus and secretions from patient lungs and improve lung function.

• Responded to numerous volatile situations and violent outbreaks to restore safety and security of patients and staff.
• Administered medication and treatments to patients to observe and record responses.
• Complied with HIPPA guidelines to protect privacy of patients.
• Educated patients and families on treatment plans and medications.
• Utilized critical thinking skills to assess situations quickly and make appropriate decisions.

• Complied with federal and state regulations for completion and coordination of RAI process.
• Verified prompt and accurate completion of MDS activities for billing.
• Assessed electronic medical record for required documentation to support MDS coding.
• Led weekly utilization review to go over recent clinical activities.
• Set schedules for staff to start and complete MDS assessments and care plan meetings.
• Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.