Charmaine Zonde
Dallas,TX
Summary
Dedicated and results-driven Registered Nurse with a strong background in healthcare pursuing Master of Business Administration (MBA) with a concentration in data analytics. Skilled in leveraging data visualization tools including Excel, Access, SQL, and Python to analyze healthcare data and derive actionable insights. Proven ability to work independently and collaboratively in fast-paced environments. A self-motivated individual with a passion for utilizing data-driven approaches to improve process outcomes and data driven decision making.
Overview
13
13
years of professional experience
1
1
Certification
Work History
QUALITY CONTROL CLAIMS REVIEW NURSE
Corvel Cooperation
Fort Worth, TX
2018 - Current
- Evaluated hospital insurance claims using the chargemaster, ensuring accuracy and identifying potential billing errors, resulting in substantial patient savings
- Reviewed line-item descriptors from hospital bills entered into CorVel’s database system, maintaining data integrity and coherence by verifying completeness, correctness, and clarity
- Collaborated with medical review and data entry departments to investigate unusual billing trends and identify recurring erroneous billing patterns
- Achieved 100% accuracy in monthly data sets, exceeding productivity targets while meeting turnaround times
- Ensured compliance with state and federal regulations, reimbursement policies, and contract requirements by staying informed about industry trends, best practices, regulations, and guidelines
- Demonstrated the ability to work independently from home while fostering teamwork through effective communication channels
- Conducted research on claim discrepancies to determine appropriate resolutions
- Actively participated in departmental meetings to provide input on workflow enhancements
HOSPITAL BILL AUDIT NURSE
Corvel Cooperation
Fort Worth, TX
2021 - 2023
- Conducted hospital bill charge audits by meticulously reviewing medical records to ensure that services were rendered and charges aligned with medical documentation and industry standards, resulting in savings ranging from $500 to $250,000 per patient
- Identified overcharges and unbundled charges according to payer contracts and industry norms, fostering billing integrity and minimizing financial discrepancies
- Detected and meticulously documented discrepancies during audits using standardized methodologies, contributing to enhanced billing accuracy and compliance with healthcare regulations
- Ensured compliance with HIPAA and other confidentiality regulations to safeguard patient information
- Offered guidance to new staff members regarding organizational policies and procedures
- Conducted thorough assessments of provider appeals to validate the accuracy of adjustments made to previous claims
- Managed multiple tasks concurrently, effectively prioritizing urgent requests from diverse departments
PCU / TELEMETRY / STEPDOWN / ICU REGISTERED NURSE (FLOATPOOL PRN)
Texas Health Resources
Arlington, TX
2017 - 2023
- Provided compassionate patient care for critically ill adult patients while ensuring compliance with HIPAA, JCAHO, Nursing Board, federal, state, and hospital regulations
- Monitored a range of life-sustaining equipment, including ventilators, bi-pap machines, telemetry monitors, cardiac output machines, ventriculostomy, pacemakers, and chest tubes
- Facilitated effective communication among physicians, case managers, charge nurses, patient care technicians, and family members to ensure coordinated care and understanding of the patient's clinical conditions and treatment plan
- Conducted comprehensive discharge planning and provided education to family members regarding patient interventions
- Stayed informed of current trends in nursing practices by actively participating in continuing education classes or seminars
ICU TRAVEL REGISTERED NURSE
Atlas Medstaff
USA
2014 - 2016
- Adapted efficiently to diverse hospital systems, each with unique processes, procedures, and Electronic Health Record (EHR) systems
- Collaborated closely with multidisciplinary team members to assess and provide care for patients in critical care settings
- Provided comprehensive hemodynamic monitoring for patients and assisted in various procedures including intubation, chest tube placement, and wound dressings
- Contributed to discharge planning efforts and provided education to family members regarding patient interventions
ICU NURSE and EMERGENCY DEPARTMENT NURSE
Providence Hospital Emergency Department
Washington D.C
06.2011 - 06.2016
- Gathered and analyzed diverse clinical data such as vital signs, acid-base balances, 12 lead ECGs, and initiating IV lines in a fast-paced emergency department setting
- Collaborated closely with interdisciplinary team members, including physicians, pharmacists, social workers, and medical residents, to implement and adhere to patient care plans effectively
- Facilitated the admission and discharge processes for patients, ensuring smooth transitions and continuity of care
- Provided guidance and mentorship to nursing students from various universities as a preceptor
MEDICAL BILLER / PATIENT CARE COORDINATOR
Keyur Shah, M.D., P.C.
Reston, VA
2007 - 2010
- Registered incoming patients, confirmed insurance eligibility, collected payments, facilitated insurance referrals, and submitted claims to insurance providers
- Prepared patients for examinations, assisted physicians with procedures, dressings, and specimen collection
- Assigned and verified appropriate ICD-9, CPT, and HCPCS codes, and applied Explanation of Benefits (EOB) details to patient accounts
- Advocated for patients by appealing claim rejections and denials, and reconciled disputes with insurance companies
- Led practice expansion initiatives, participated in continuing education activities, and provided training to new employees
- Conducted follow-up actions on unpaid claims with insurance companies or other third-party payers via phone or written correspondence
- Generated reports to monitor outstanding payments from insurance companies
Education
MBA - Data Analytics
Texas A&M University - Corpus Christi
Corpus Christi, TX12-2024
Bachelor of Science - Nursing
Liberty University
Lynchburg, VA05-2012
Skills
- Microsoft Access /Microsoft Excel / SQL / Python
- ICD-10 / CPT / HCPCS
- HIPAA
- EPIC / Meditech
- Process Improvement
- Hospital Bill Auditing
- Provider Appeals
- Quality Assurance
- Medical Billing & Coding
- Medicare & Medicaid
- Microsoft office Suite
- Critical Care Medication Titration
- Cardic & Neurological Care
Certification
- Registered Nurse Compact License
Timeline
ICU NURSE and EMERGENCY DEPARTMENT NURSE
Providence Hospital Emergency Department
06.2011 - 06.2016
MBA - Data Analytics
Texas A&M University - Corpus Christi
Bachelor of Science - Nursing
Liberty University
QUALITY CONTROL CLAIMS REVIEW NURSE
Corvel Cooperation
2018 - Current
HOSPITAL BILL AUDIT NURSE
Corvel Cooperation
2021 - 2023
PCU / TELEMETRY / STEPDOWN / ICU REGISTERED NURSE (FLOATPOOL PRN)
Texas Health Resources
2017 - 2023
ICU TRAVEL REGISTERED NURSE
Atlas Medstaff
2014 - 2016
MEDICAL BILLER / PATIENT CARE COORDINATOR
Keyur Shah, M.D., P.C.
2007 - 2010
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