Tyana Brown
American Mercy Home Care
Cincinnati,OH
1
Certification
9
years of professional experience
Dynamic nursing professional with over a decade of experience in integrating clinical care with healthcare operations, specializing in authorization management, utilization oversight, and patient access coordination. Proven ability to navigate complex payer systems and interpret coverage policies, ensuring appropriate level-of-care decisions across diverse healthcare settings. Recognized for fostering strong collaborative relationships with providers, administrative teams, and insurers to eliminate barriers to care and enhance service delivery. Committed to advancing patient advocacy, operational excellence, and system accountability in every aspect of practice.
Work History
Client Relations Support Associate
4 Years 8 Months- Oversaw patient referral processes to enhance service access. Assessed eligibility criteria for various services. Facilitated home care arrangements to support patient needs.
- Established and nurtured relationships with healthcare providers to advocate for best practices in homecare services.
- Evaluated patient requirements to inform caregivers about available home care options and insurance benefits.
- Coordinated efforts with hospitals and nursing home health staff to ensure delivery of high-quality patient care.
- Developed and organized accurate records for each key referral source to facilitate access to client information and improve customer satisfaction.
- Ensured accurate and timely submission of all necessary documentation to support operational efficiency.
- Facilitated timely processing of approved physician orders to enhance patient care.
- Provided exceptional customer service, addressing client inquiries and resolving issues promptly.
- Assisted in coordinating care plans, ensuring alignment with patient needs and preferences.
Patient Services Liaison
4 Years 11 Months- Serve as a subject matter expert and primary liaison for physicians, clinics, pharmacies, payors, and stakeholders, delivering consultation, education, and service integration support.
- Lead specialty pharmacy coordination, including referrals, prior authorizations, EMR documentation, and prescription capture optimization to improve access and continuity of care.
- Navigate complex healthcare systems to coordinate care, ensure prescription fulfillment, and improve patient outcomes across clinical, pharmacy, and hospital services.
- Conduct medical necessity reviews and utilization management using approved clinical criteria to support appropriate admissions, level-of-care decisions, and continued stay determinations.
- Collaborate with interdisciplinary teams, financial clearance, revenue cycle, and patient access departments to resolve authorization, billing, denial prevention, and payer barriers.
- Implement process improvements and quality initiatives that enhance patient experience, support CMS quality indicators, and strengthen revenue integrity and system performance.
Licensed Practical Nurse
1 Year 3 Months- Delivered pediatric clinical care while supporting care coordination, access to services, and appropriate utilization of healthcare resources.
- Managed clinic workflows, scheduling, and patient communications to improve care access, continuity, and operational efficiency.
- Documented care in Epic EHR and supported prior authorizations, referrals, and prescription processing in alignment with payer and medical necessity requirements.
- Assisted with utilization review activities by coordinating documentation, supporting medical necessity workflows, and facilitating communication between providers and administrative teams.
- Collaborated with physicians, nurses, and clinic leadership to support appropriate level-of-care decisions and efficient patient management.
- Supported compliance, documentation accuracy, and care coordination processes in accordance with regulatory and payer guidelines.
- Administered medications and treatments as prescribed by pediatricians, ensuring patient safety and compliance.
- Monitored patients' vital signs, reporting any changes to healthcare team for timely intervention.
LPN Charge Nurse
3 Years 11 Months- Provided compassionate and skilled care to diverse geriatric populations in long-term care and rehabilitation settings.
- Executed medication administration, catheterizations, tube feedings, and wound care while implementing strategies to reduce medication errors and infection risks.
- Identified and escalated changes in residents' health status to ensure prompt interventions and enhance care continuity.
- Facilitated collaboration among interdisciplinary teams, including physicians, therapists, and social workers, to develop, implement, and evaluate individualized care plans.
- Maintained comprehensive records of care delivery and patient progress, adhering to regulatory and organizational standards for incident reporting.
- Facilitated efficient admission, transfer, and discharge processes for residents, ensuring seamless transitions and continuity of care.
Education
Diploma - Practical Nursing
Skills
Utilization Review Support
Medical Necessity Documentation
Care Coordination & Care Navigation
Prior Authorization Management
Insurance Verification & Benefit Analysis
Revenue Cycle & Reimbursement Support
Denial Prevention & Appeals
Specialty Pharmacy Coordination
Intake & Access Management
Quality Improvement Initiatives
CMS & Payer Compliance
Regulatory Documentation
Interdisciplinary Collaboration
Patient Advocacy
Process Improvement
Data Tracking & Reporting
Epic EHR / Epic MyChart
Authorization & Intake Platforms
Claims & Billing Systems
Customer support
Customer relations
Documentation skills
Call center experience
Certification
- License Practical Nurse
- LPN.163435.MEDS-IV
- Aug 2016 – Current
- Single State, Ohio
Timeline
Client Relations Support Associate
American Mercy Home Care
12.2021 - CurrentRead More
Patient Services Liaison
Cencora
04.2021 - 03.2026Read More
Licensed Practical Nurse
Tri-Health Group Health Pediatrics
01.2020 - 04.2021Read More
LPN Charge Nurse
Maple Knoll Communities
04.2017 - 03.2021Read More
Cincinnati State Technical Community College
Diploma from Practical Nursing
Read More