Summary
Overview
Work History
Education
Skills
Timeline
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Brittany Biswas

Charleston,WV

Summary

Highly motivated and organized RN with clinical and coding training specializing in DRG and readmissions claim reviews. Experienced charge nurse in the ICU department and member of the MET team at Charleston Area Medical Center. Skilled in phase 1 and phase 2 DRG reviews as a Payment Integrity Clinician, contributing to projects like the Inpatient Facility Diagnosis Guidelines and neonatal respiratory distress initiatives. Dedicated to mentoring newly hired clinicians and conducting readmissions reviews for the Payment Integrity team.

Overview

13
13
years of professional experience

Work History

Registered Nurse - Private Physician Group

Mountaineer Family Practice
  • Obtained vital signs and updated medication lists with patients.
  • Administered vaccinations and recorded in EMR.
  • Obtained blood and lab samples from patients and maintained them for LabCorp daily pickup.
  • Recorded all patient information in EMR.
  • Coordinated with insurance companies on prior authorizations and patient record review.
  • Maintained vaccination logs and records for the clinic.

Payment Integrity Clinician

Highmark, Inc.
01.2022 - Current

Performed clinical/coding reviews for phase 1 and phase 2 prepay and postpay DRG and readmission claims. Implemented pre-payment and retrospective review processes for claims, ensuring compliance with industry and corporate standards. Served as a mentor for several clinicians and performed clinical review findings letter peer reviews. In October 2022, received the Silver Applause Award for efforts in applying gestational diabetes diagnosis codes that our team could apply to applicable neonatal claims that resulted in maximum savings. This finding resulted in a lookback of claims that pertained to the targeted diagnosis codes, which resulted in $252,207.86 savings for the payment integrity team. Participated in the lookback project of neonatal hypoglycemia claims despite being a new clinician with only a few weeks experience. Participated in another claim lookback project in 2023 for respiratory distress syndrome with two fellow clinicians that resulted in nearly 2 million dollars in savings outcome. Participated in the creation/implementation of the Inpatient Facility Diagnosis Guidelines for the PI Clinical team. Assisted with the testing for claimHub and claimDrop updates. Collaborated on the MDC-14 project to perform manual DRG reviews to test the accuracy of AI technology for adjustment thresholds in 2024. Began performing Readmission claim reviews in January 2025.

RN - Critical Care

Charleston Area Medical Center
09.2013 - 10.2016
  • Helped physicians complete procedures such as endoscopies and bronchoscopies.
  • Assessed patients' pain levels and sedation requirements.
  • Controlled risks of deterioration with continuous monitoring and swift action on concerning changes in condition.
  • Prioritized care for critically-ill patients, balancing emerging needs against core requirements.
  • Monitored patients for changes in status and indications of conditions such as sepsis or shock and instituted appropriate interventions.
  • Administered medications intravenously, by injection, orally, through gastric tubes, and by [Type] methods.
  • Prevented and treated serious conditions such as sepsis and shock.
  • Identified abnormal respiratory patterns and breathing sounds with regular pulmonary assessments.
  • Supported patients during emergencies, quickly identifying and delivering life-saving treatments.
  • Evaluated patients' vital signs and laboratory data to determine emergency intervention needs.
  • Detected emerging issues such as fluid and electrolyte imbalances by monitoring fluid intake.
  • Updated charts in [System], documenting medical histories, assessment findings, and treatments.
  • Served as relief charge nurse and MET (Medical Emergency Team) nurse.

Medical Surgical Registered Nurse

CAMC
03.2012 - 09.2013
  • Supported continuum of care through care plan development and implementation.
  • Assessed patient needs and risk factors through careful interpretation of patient health history.
  • Educated families and caregivers on diagnosis, prognosis, and treatment plans.
  • Facilitated quality care and seamless shift changes with meticulous documentation and charting practices.
  • Responded to medical alarms and emergent needs to deliver focused and compassionate care.
  • Assessed and treated medical and post-surgical wounds.
  • Administered medications to patients and educated caregivers regarding side effects and contraindications.
  • Advocated for patient needs within healthcare team and collaborated to develop appropriate treatment options.
  • Coordinated patient care and nursing workflows to manage high volume caseloads with available resources.
  • Served diverse patient populations with thorough knowledge of diverse injuries, surgical services, and disease states.
  • Administered medications to patients and monitor patients for reactions or side effects to quickly intervene in serious issues.
  • Enhanced patient outcomes through careful monitoring of conditions and comprehensive support.
  • Contributed to team efficiency, optimal patient flow, and accuracy in treatments by maintaining accurate and detailed reports and records.
  • Stabilized patients during emergencies with first aid and life support care.
  • Resolved or reduced patient symptoms with intramuscular, intravenous and oral medicines.
  • Modified patients' treatment plans as indicated by patients' responses and new physician orders.

Education

Bachelor of Science - Nursing

Mountain State University
Beckley, WV
10.2011

Bachelor of Science - Biology

Alderson Broaddus University
Phillippi, WV
05.2008

High school diploma - undefined

Tygarts Valley High School
Mill Creek, WV
05.2004

Skills

  • Critical thinking
  • Microsoft Word
  • OneNote
  • Task prioritization
  • Technological savvy
  • Great at maintaining and fostering work relationships
  • Time management
  • Recordkeeping
  • Multitasking
  • Organized
  • Proficient in claims management systems
  • Quality assurance
  • Power Point proficiency
  • Upbeat, energetic, and highly motivated
  • Works well with others
  • Collaboration skills

Timeline

Payment Integrity Clinician

Highmark, Inc.
01.2022 - Current

RN - Critical Care

Charleston Area Medical Center
09.2013 - 10.2016

Medical Surgical Registered Nurse

CAMC
03.2012 - 09.2013

Registered Nurse - Private Physician Group

Mountaineer Family Practice

Bachelor of Science - Nursing

Mountain State University

Bachelor of Science - Biology

Alderson Broaddus University

High school diploma - undefined

Tygarts Valley High School