Christine Warshel
Syracuse,NY
Summary
Dynamic and results-driven Licensed Practical Nurse (LPN) with extensive experience in diverse healthcare settings, including acute, long-term care, and home care. Skilled in managing patient care, supervising teams, and ensuring regulatory compliance. Experienced in the insurance industry with expertise in claims management, bill review operations, fraud investigations, and training teams. Renowned for strong leadership, negotiation, communication, and analytical skills.
Overview
31
31
years of professional experience
Work History
Provider Outreach & Education Representative
NGS-Anthem
East Syracuse, NY
02.2017 - Current
- Build and maintain relationships with providers, insurers, and administrators to enhance Medicare services.
- Educate healthcare providers on Medicare regulations, operational changes, and documentation requirements through training sessions.
- Research and resolve operational issues related to provider grievances and regulatory compliance.
- Demonstrate expertise in claims analysis, and CMS systems to improve service efficiency.
- Leverage communication skills to clarify complex industry regulations and streamline issue resolution.
LPN Nurse Review / CERT Part A
NGS-Anthem
East Syracuse, NY
08.2013 - 02.2017
- Analyzed institutional and professional claims for medical necessity in compliance with Medicare guidelines.
- Reviewed detailed medical documentation and rendered payment determinations effectively.
- Authored comprehensive summaries addressing claims processing issues, ensuring compliance with federal regulations.
- Contacted healthcare providers to obtain missing documentation for operational improvements.
Medical Bill Review Supervisor
CorVel Corporation
North Syracuse, NY
01.2005 - 01.2013
- Managed bill review operations for workers' compensation and no-fault claims while aligning workflows with client needs.
- Supervised daily operations and coordinated teams of analysts to ensure efficiency and accuracy.
- Partnered with IT teams to develop and implement advanced software solutions for claims processing.
- Led efforts to streamline functions within claims operations and reduce company costs by consolidating workflows.
- Delivered training programs to support new client onboarding and regulatory compliance.
Licensed Practical Nurse (LPN)
St. Camillus Rehabilitation
Syracuse, NY
01.2004 - 01.2005
- Charged with overseeing nurse aides, completing performance evaluations, and assigning tasks.
- Conducted patient assessments, developed care plans, and executed medication/treatment orders.
- Maintained accurate documentation and provided detailed patient handovers for seamless care transitions.
- Assisted physicians with bedside procedures and ensured adherence to hospital standards.
Master Claims Representative
Nationwide Insurance
Liverpool, NY
01.1995 - 01.2003
- Managed complex no-fault claims through litigation and settlement, providing expert guidance on medical aspects.
- Conducted functional oversight, assigning cases and supervising claims processing teams.
- Facilitated independent medical exams (IMEs) and communicated effectively with attorneys for accurate representation.
- Collaborated with the Special Investigations Department for fraud detection and resolution.
- Educated new claim representatives on regulatory guidelines and arbitration decisions.
Education
Licensed Practical Nurse (LPN) -
Greater Johnstown Area Vocational Technical School
Johnstown, PAPhlebotomy Certification -
OCM BOCES
Liverpool, NYSkills
- Patient Care & Assessment
- Medication Management & Administration
- Team Leadership & Training
- Negotiation & Settlement
- Claims Processing (Workers' Compensation, No-Fault)
- Operational Optimization
- Documentation & Reporting
- Workflow Development & Client Integration
Timeline
Provider Outreach & Education Representative
NGS-Anthem
02.2017 - Current
LPN Nurse Review / CERT Part A
NGS-Anthem
08.2013 - 02.2017
Medical Bill Review Supervisor
CorVel Corporation
01.2005 - 01.2013
Licensed Practical Nurse (LPN)
St. Camillus Rehabilitation
01.2004 - 01.2005
Master Claims Representative
Nationwide Insurance
01.1995 - 01.2003
Licensed Practical Nurse (LPN) -
Greater Johnstown Area Vocational Technical School
Phlebotomy Certification -
OCM BOCES