Ashley Grider
Tompkinsville,KY
Summary
Accomplished Medical Review Nurse with expertise in claim review, chart auditing, and policy compliance. Proven ability to ensure accurate reimbursement for DME and home health services.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medical Review Nurse III
Performant Recovery
Pleasanton, California
04.2021 - Current
- Currently, I perform retrospective reviews on claims submitted for payment to determine accurate reimbursement levels based on applicable policies and procedures. Areas of audit experience include: Durable Medical Equipment (DME), home health, and inpatient rehabilitation facility for both Medicare and commercial payors.
RN Case Manager
Lifeline Home Health
Tompkinsville, Kentucky
03.2017 - 04.2021
- Supervised a clinical team and was responsible for the direction of patient care which included case management, chart review, oasis review, diagnosis coding verification, prior authorization, and utilization review.
Med-Surg RN
Monroe County Medical Center
Tompkinsville, Kentucky
11.2011 - 03.2017
- Medical-surgical floor nurse providing direct patient care, administration of medications, assisting during bedside surgical procedures, discharge planning, and patient teaching.
Education
Bachelor of Science - Nursing
Western Kentucky University
Bowling Green, KY12-2013
Associate of Science - Nursing
Western Kentucky University
Bowling Green, KY12-2010
Skills
- Claim review
- Chart auditing
- Policy compliance
- Time management
- Diagnosis coding
- Effective organizational and prioritization skills, with multi-tasking ability
- Computer proficiency in the MS Office suite
- Understanding ICD, HCPCS, HIPPS codes, and federal and state guidelines, including CMS
Certification
- Kentucky board of Nursing Licensure received 03/30/2011
- OIG clearance
Timeline
Medical Review Nurse III
Performant Recovery
04.2021 - Current
RN Case Manager
Lifeline Home Health
03.2017 - 04.2021
Med-Surg RN
Monroe County Medical Center
11.2011 - 03.2017
Bachelor of Science - Nursing
Western Kentucky University
Associate of Science - Nursing
Western Kentucky University
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