Summary
Overview
Work History
Education
Skills
Certification
Aptitudes
References
Timeline

Betty Sheridan

Registered Nurse
Malvern,PA

Summary

Goal oriented, innovative medical professional receptive to opportunities where my developed teamwork skills and my seasoned communication style will improve efficiency of business operations and increase organizational success.

Successful, Registered Nurse with solid experience in all aspects of patient centered healthcare service management. Dedicated Healthcare Professional with broad medical and clinical experiences in hospital, office and corporate office environments. Knowledgeable in Medicare compliance regulations, Provider relationships, Case Management, UM, Discharge planning, healthcare service screenings, healthcare client triage and clinical record/case audits. Recognized for an ability to build, maintain and proactively manage trusted partnerships with business partners.

Overview

45
45
years of professional experience
1
1
Certification

Work History

Central Appeals Unit

Mercy Health System (Trinity Health)
10.2014 - Current
  • Facilitate inpatient retrospective revenue recovery for 4 system hospitals
  • Access inpatient electronic medical record to evaluate and draft appeal letters for: Medicare, Medicaid, and Commercial Carrier service denials.

Electronic Health Record, Clinical Implementation Specialist

Executive Health Resources (United Health Group)
01.2009 - 07.2013
  • Increased company’s revenue through implementation of 400 client electronic referral solutions
  • Worked directly with internal management, operational departments, and external clients to support company goals
  • Partnered with internal teams and external client (hospitals) to evaluate, develop, and implement electronic referral projects physician record reviews
  • Designed individualized external client (clinical teams) educational documents for newly implemented workflow
  • Provided multimedia training/education to external clients and internal support team on client’s specific electronic referral process
  • Audited project success post implementation and client satisfaction through internal data reviews and follow-up telephonic assessments with key project partners.

Registered Nurse, Manager of Client Services

Executive Health Resources (United Health Group)
01.2008 - 01.2009
  • Communicated directly with internal physician management and physician operational teams to support company Medicare review service
  • Managed and facilitated 6-physician team workflow developed strategies and tools for increased productivity
  • Performed quality review of internal physicians’ Medicare compliance documentation for accuracy, appropriateness of decisions and adherence to company policies
  • Educated new physicians, nurses and administrative staff regarding corporate policies, procedures, Medicare compliance and hospital case management functions
  • Coordinated client -physician telephonic meetings to assess clients’ understanding of EHR Medicare compliance programs and developed solutions for client concerns.

Registered Nurse, Health Advocate

Health Advocate
01.2006 - 01.2008
  • Reduced/controlled employer based (client) medical expenses and employee lost time revenue
  • Advocacy of 100 employee’s healthcare concerns via telephonic triage with development of problem resolution/solutions.

Registered Nurse, Certified Case Manager

Mercy Suburban Hospital
01.2004 - 01.2006
  • Case Management reviews of inpatient admissions (45 patients) both commercial payer and Medicare population for medical appropriateness
  • Utilized InterQual criteria, ICD-9 coding and case management healthcare screens for optimum level of hospital service, safe patient discharge and as needed development of cost contained alternatives.

Certified Case Manager, Workman’s Compensation

Intracrop/Cigna
01.1998 - 01.2001

Discharge Planner, Case Manager

Olsten Kimberly Quality Care
01.1995 - 01.1998

Homecare Case Manager

Aetna
01.1994 - 01.1995

Catastrophic Case Manager

US Healthcare/CHA
01.1991 - 01.1994

Education

RN Diploma -

Bryn Mawr Hospital School of Nursing

Bachelor of Arts, Organizational Management -

Eastern University

Skills

  • Professionalism and Ethics
  • Attention to Detail
  • Organizing and Prioritizing Work
  • Customer Service
  • Critical Thinking
  • Active Listening
  • Continuous learning mindset
  • Organizational abilities
  • Teamwork and Collaboration

Certification

  • Certified Case Manager (CCM)
  • ICD-10
  • Certified Childbirth Educator
  • Business Writing

Aptitudes

  • Well-developed, cross-functional team communication and dynamic interpersonal skills
  • Seasoned medical physician and support team management ability
  • Detail oriented, resourceful problem solver, flexible and adaptable to change
  • Solid ability to prioritize, organize and manage time efficiently
  • Motivated, hardworking, willing to share knowledge and help others grow in their positions

References

Available upon request

Timeline

Central Appeals Unit - Mercy Health System (Trinity Health)
10.2014 - Current
Electronic Health Record, Clinical Implementation Specialist - Executive Health Resources (United Health Group)
01.2009 - 07.2013
Registered Nurse, Manager of Client Services - Executive Health Resources (United Health Group)
01.2008 - 01.2009
Registered Nurse, Health Advocate - Health Advocate
01.2006 - 01.2008
Registered Nurse, Certified Case Manager - Mercy Suburban Hospital
01.2004 - 01.2006
Certified Case Manager, Workman’s Compensation - Intracrop/Cigna
01.1998 - 01.2001
Discharge Planner, Case Manager - Olsten Kimberly Quality Care
01.1995 - 01.1998
Homecare Case Manager - Aetna
01.1994 - 01.1995
Catastrophic Case Manager - US Healthcare/CHA
01.1991 - 01.1994
Bryn Mawr Hospital School of Nursing - RN Diploma,
Eastern University - Bachelor of Arts, Organizational Management,

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Betty SheridanRegistered Nurse