Brooke Weaver
Kirkwood,MO
Summary
Experienced and registered nurse specializing in pediatric nursing, utilization management, clinical appeals, and denials. Currently working with commercial insurance payers, as well as Missouri and Illinois managed Medicaid plans. Possesses strong clinical skills and excels in building rapport with patients and their families. Patient-oriented nurse with 9 years of diverse experience in direct patient care, staff supervision, and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offers expertise in pediatric specialty.
Overview
11
11
years of professional experience
Work History
Utilization Review Manager- Appeals Team
BJC Revenue Cycle Management
07.2018 - Current
- Responsible for reviewing insurance denials for Saint Louis Children’s Hospital and Progress West Hospital
- Communicate with Care Coordination manager at Saint Louis Children’s Hospital weekly regarding denial trends
- Responsible for ensuring guidelines are followed according to corporate compliance
- Communicate with care coordinators at different HSO’s regarding admission orders, denials, and peer to peer evaluations
- Responsible for correct NICU level of care is being billed appropriately per A4 guidelines
- Interqual certified
- Review and ensure claims are billed and paid according to managed care contracts with BJC
- Responsible for managing all private room charges for BJC facilities system wide
Home Care Nurse
Accucare
02.2024 - Current
- Provide inpatient registered nursing care in a patients home
- Assist with all aspects of daily care; including tube feeds, bathing, oral care
- Extensive trach/vent experience
Co-Owner
Duck Donuts
07.2017 - 08.2023
- Hiring and onboarding all employees
- Coordinate payroll biweekly
- Manage all food orders through sysco weekly
- Responsible for all aspects of store operation
Registered Nurse Manager
Urgent Care for Kids
05.2014 - 01.2022
- Perform triage on all patients and rank acuity in priority for Physician and Nurse Practitioners
- Duties include routine blood drawing, laceration repairs, nebulizer treatments, CLIA waived testing, wound dressing, well physicals, strep, flu, and influenza testing
- Call all patients from previous evening for progress status and lab work follow up
- Responsible for verifying all insurance information and computing correct deductibles and co-pays that are due at time of service
- Extensive background communicating with Commercial and Missouri managed Medicaid plans including Home State Health, Missouri Care, and Aetna for Better Health
- Precertify nebulizers and other related durable medical equipment with preferred contracted providers
Care Coordinator, RN
St. Louis Children’s Hospital
02.2016 - 07.2018
- Care Coordinator on Hematology/ Oncology floor
- Responsible for notifying the insurance company for each patient upon admission
- Round every morning with the Hematology/ Oncology medical team to develop plan of care
- Send updated clinical information on each patient to insurance companies on a daily basis
- Coordinate every aspect of home health care prior to discharge, and confirm in-network and out-of-network DME and nursing providers
- DME included central line and NG tube supplies, and LTV and Trilogy vents, private duty nursing
- Assure appropriate levels of care are billed, depending upon which location they are housed in the hospital
- Appeal each insurance company denial on the Oncology floor and work to overturn decisions
Staff RN
St. Louis Children’s Hospital
01.2015 - 02.2016
- Worked on Pulmonary and ICU overflow floor, treating high acuity inpatient children
- Extensive experience with tracheostomy and ventilator patients
- Trach changes
- LTV and Trilogy vent trained
- Tracheostomies with HMEs
- Work closely with asthmatic admissions
- Certified in asthma action plan training
- Experience with G-buttons and NG tube feeds
- Trained on central lines; PICC and port access
- Assist with cystic fibrosis patients and implementing their treatment plans
- Coordinate inpatient care, admissions, and discharge planning with Attending Physicians and Residents
Education
Master of Health Administration -
Webster University
Saint Louis, MO08.2019
Bachelor of Science - Nursing
Saint Louis University
Saint Louis, MO05.2014
Skills
- Case management and documentation
- Background in insurance
- Dispute Resolution
- Denied claims identification
- Claims resolution
- Compliance procedures
- Utilization review
- At-home healthcare
References
- Tori Bray, Vice-President of Urgent Care for Kids, (314)- 330-3821
- Arzy Shaughnessy Harlan, Assistant Director of Nursing Accucare, 309-231-0293
- Barbra Bollasina, Supervisor BJC Clinical Appeals, Bb39042@bjc.org
Qualifications Summary
Registered Nurse with extensive background in pediatric nursing, UM, and clinicals appeals and denials. Currently working with commercial insurance payers, Missouri and Illinois managed Medicaid plans. Strong clinical skills enhanced by ability to build rapport with patients and families.
Collegiate field hockey umpire
Umpire BIG 10, ACC, American East, MAC, Northeast Conferences. Umpired the MIssouri State finals 2021, 2022, 2023, and 2024. Umpire of the year 2021 and 2024.
Timeline
Home Care Nurse
Accucare
02.2024 - Current
Utilization Review Manager- Appeals Team
BJC Revenue Cycle Management
07.2018 - Current
Co-Owner
Duck Donuts
07.2017 - 08.2023
Care Coordinator, RN
St. Louis Children’s Hospital
02.2016 - 07.2018
Staff RN
St. Louis Children’s Hospital
01.2015 - 02.2016
Registered Nurse Manager
Urgent Care for Kids
05.2014 - 01.2022
Bachelor of Science - Nursing
Saint Louis University
Master of Health Administration -
Webster University
Similar Profiles
Debora DallingaDebora Dallinga
Account Specialist at Convergent Revenue Cycle ManagementAccount Specialist at Convergent Revenue Cycle Management
Lydia R. RoehlLydia R. Roehl
Managing Consultant at Healthcare Revenue Cycle Management, Guidehouse INCManaging Consultant at Healthcare Revenue Cycle Management, Guidehouse INC
MONICA RIVERAMONICA RIVERA
Account Specialist at Convergent Revenue Cycle ManagementAccount Specialist at Convergent Revenue Cycle Management