Multistate licensed registered nurse with a strong background in nurse auditing within claims administration and Payment Integrity. Exceptional communication, interpersonal, and organizational skills in both Spanish and English. Extensive hands-on clinical experience in Home Health and Acute hospital settings, highlighting adeptness in navigating challenges. Proactive problem-solving abilities facilitate efficient completion of new tasks. Recognized for adaptability, creativity, and a results-oriented mindset, dedicated to making impactful contributions and advancing organizational goals.
Audit Home Health and SNF claims.
Review utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse.
Performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement.