DIANE MCCOURT

• Oversee HIM, Coding, Clinical documentation & Denials
• Reduced coding turnaround time by over 40% within first month through workload management, communication, software improvement
• Championed change management efforts during organizational restructuring periods - Epic rise/refuel project
• Lead process improvement projects to reduce inefficiencies within the organization: A3 projects and training
• Strengthened vendor relationships by maintaining open communication and promptly addressing any concerns or issues
• Improved claim denial resolution by thoroughly researching and identifying root causes of DRG related denials
• Researched existing policies and procedures to gain firm understanding of current conditions and recommend/implement updates

• Guided a team of 8 nurses through new department development and organizational change
• Prior authorization policy review/submission for major joints, spines, and high-risk denial surgical procedures
• Analyzed/identified denial trends with solution implementation
• Led interdepartmental collaboration
• Developed and sustain departmental resources.
• Instructed providers and representatives on payer policies
• Developed excel tools for accurate clinical documentation submission
• Served as clinical expert resource for fellow nurses
• Facilitated training sessions

Payer Denial Management (October 2020 - April 2022)
• Improved claim denial resolution by thoroughly researching and identifying root causes of denials: Commercial and Medicare, inpatient and outpatient, against MCG, InterQual, LCD, NCD, and payer policy/guidelines
• Review and appeal Medicare and Medicaid audits (Prism, Ciox, RAC, MAC, Permidion)
• Served as subject matter expert on claim denials, providing guidance and support to colleagues across departments
• Conducted root cause analyses of recurring denials, identifying areas for improvement within organization's processes and systems
• Epic/Epic Resolute documentation

Observation Charge Capture (January 2018 - April 2022)
• Oversaw integration of coding team consisting of 8 coders
• Reviewed up to 38 Observation related admissions daily and capturing charges in Epic Resolute against CMS guidelines while maintain accuracy score of >96%
• Identified areas for process improvement, resulting in increased efficiency within department: consistency committee (policy and guidelines), A3 classes, Kaizen projects, Six Sigma - yellow belt
• Precepted new nurses and coders following established standards of practice and organizational policies

• Collaborated with interdisciplinary team members for optimal patient outcomes in end-of-life care.
• Managed caseloads, up to 19 patients, efficiently by prioritizing tasks according to urgency and complexity, ensuring all patients received appropriate attention.

• Evaluated patient histories, complaints, and current symptoms
• Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms
• Performed triage on incoming patients and determined severity of injuries and illnesses
• Precepted new nurses, providing guidance on unit functions and individual roles, hospital policies and procedures and nursing best practices.

• Decreased wait times for patients by efficiently triaging and prioritizing cases based on severity and urgency.
• Provided high-quality emergency nursing care for up to 7 patients
• Assisted in development of departmental policies and procedures by providing input on best practices based on professional expertise
• Continuously updated knowledge on professional development opportunities: TNCC, PALS, NRP, BLS, ACLS
• Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols
• Assisted in software implementation projects resulting in improved workflow across departments by becoming Allscripts Superuser
• Improved interdepartmental communication by proactively addressing questions and concerns from by serving on nursing counsel
• Conducted interviews with participants to assess eligibility

• Demonstrated excellent critical thinking skills while managing multiple high-acuity patients at once, making quick decisions under pressure to optimize patient outcomes.
• Assisted new hires in developing critical thinking skills and applying evidence-based practice guidelines to improve patient care.

• Conducted thorough neurological assessments to monitor changes in patients' conditions closely
• Handle ventilators effectively by managing complex respiratory issues associated with neurological injuries or diseases
• Contributed towards department quality improvement initiatives by identifying areas of potential improvement within unit's operations
• Accurately accessed and communicated staffing needs within to address appropriate patient care through charge nurse role
• Floated as needed to Medical and Surgical Intensive care units