Carrie Burgess
Liberty,SC
Summary
Dynamic clinical professional with extensive experience at Cotiviti, excelling in complex audits and demonstrating a self-directed work ethic. Proven expertise in ICD-10-CM coding and detail-oriented analysis, consistently exceeding productivity goals while fostering collaborative teamwork to enhance audit efficiency and identify trends for recovery opportunities.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Auditor Clinical Validation OPSP
Cotiviti
06.2021 - Current
- Conduct complex audits utilizing medical chart coding principles and client specific guidelines to identify potential billing, coding, and medical necessity issues.
- Demonstrated ability to exceed set productivity and quality standards.
- Proven confidence with clinical judgement determinations including accurate and concise documentation of decision outcomes and rationales.
- Exhibited independence with self study across various platforms, audit tools, and review concepts.
- Recommended improvements to enhance audit efficiency, and reported any identified trends with recovery possibilities to Team Lead.
Clinical Nurse Reviewer
HMS
06.2018 - 06.2021
- Conducted complex medical record reviews to determine accuracy of coding, billing and necessity.
- Made clinical determinations based on Medicare and various commercial insurance guidelines.
- Accurately documented decision outcomes and rationales.
- Trained in various review concepts.
- Maintained and exceeded production and quality goals.
MDS Coordinator
Foothills Presbyterian Community
02.2014 - 06.2018
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
- Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.
MDS Coordinator
Magnolia Place of Greenville
11.2012 - 02.2014
- Effectively managed Medicare A and Managed Care case loads of up to 40 residents to ensure optimum reimbursement.
- Scheduled and coordinated completion of resident assessments in accordance with current Federal and State regulations.
- Lead daily IDT meetings and monthly triple check meetings.
- Provided ongoing education for nursing staff regarding MDS best practices, contributing to a knowledgeable and skilled workforce.
MDS Coordinator
NHC HealthCare, Mauldin
10.2011 - 11.2012
- Completed resident assessments and care plans in accordance with current Federal d State regulations.
Director of Nursing
Emeritus Corp.
03.2011 - 09.2011
- Coordinated medical and health services in compliance with government regulations and policies set by board of trustees.
- Reviewed incident reports for accuracy, proper notifications to families and physicians, and potential trends.
- Assessed competence of clinical staff.
- Resolved conflicts promptly among all healthcare staff, resident's and families as needed.
Assistance Director of Nursing
Magnolia Place of Greenville
06.2006 - 03.2011
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Collaborated with staff, management, and external groups to coordinate patient care.
- Performed rounds to observe care and interview staff, residents, and families.
- Managed nursing schedules and budgets, streamlining processes for cost savings while maintaining high-quality patient care.
- Responsible for new hire orientation.
- Managed Restorative Nursing Program
- Completed MDS assessments as needed.
Registered Nurse, Neuroscience
Greenville Healthcare System
05.2004 - 06.2006
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Addressed unit staff concerns, staffing ratios, allocation of responsibility, and optimized work loads as Charge Nurse.
Education
Nursing
Greenville Technical College
Greenville, SC04-2004
Skills
- Self-directed work ethic
- Proficient in organizing workload efficiently
- Detail-oriented analysis
- Trend and pattern recognition
- Experienced in ICD-10-CM coding practices
- Clear communication
- Collaborative teamwork
- Proficient in Word and Excel
Certification
- Registered Nurse in South Carolina, License # 95322
- CPC 2024
Timeline
Auditor Clinical Validation OPSP
Cotiviti
06.2021 - Current
Clinical Nurse Reviewer
HMS
06.2018 - 06.2021
MDS Coordinator
Foothills Presbyterian Community
02.2014 - 06.2018
MDS Coordinator
Magnolia Place of Greenville
11.2012 - 02.2014
MDS Coordinator
NHC HealthCare, Mauldin
10.2011 - 11.2012
Director of Nursing
Emeritus Corp.
03.2011 - 09.2011
Assistance Director of Nursing
Magnolia Place of Greenville
06.2006 - 03.2011
Registered Nurse, Neuroscience
Greenville Healthcare System
05.2004 - 06.2006
Nursing
Greenville Technical College
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