Hattie Garcia, LVN
Dale,TX
Summary
Detail-oriented nurse serving in the realm of quality assurance with 10+ years of experience. Strong organizational skills with the ability to handle multiple projects with a high degree of accuracy. Detail oriented team player with a passion to help team achieve company goals.
Overview
6
6
years of professional experience
Work History
Community Liaison
AccentCare
01.2023 - 04.2023
- Manage HCHB workflow for daily processing that result in generated orders needing to be sent or resent to physicians for signature.
- Organize orders for delivery to each physician/provider using his/her preferred method for receiving orders.
- Track outstanding orders and complete follow-up tasks to ensure orders are received signed appropriately and in a timely manner.
- Complete orders management process for signed orders by receiving the orders, processing them as received into the EMR, and attaching orders.
- Escalate orders appropriately that are in jeopardy of not being returned timely, while working with branch staff and educating them as to need.
Pre Claim Review Auditor
AccentCare
08.2020 - 12.2022
- Reviewed all documents including orders, plan of care, F2F documents while maintaining confidentiality with all patient data as per company and HIPPA.
- Monitored workflow reports regularly to make sure review of claims was conducted efficiently and in a timely manner.
- Interacted daily with branch employees cultivating positive working relationships while documents needed to bill were signed and returned in a timely manner.
- Submitted claims manually utilizing secure CMS portal as needed.
- Attended weekly meetings regarding new CMS guidelines, company goals and outstanding AR for branches.
Utilization Management Nurse
Nexus
04.2019 - 08.2019
- Performed independent clinical review of concurrent and retrospective workman's compensation claims utilizing specialty physician review, evidence-based recommendations as well as state guidelines to determine outcome.
- Submitted review findings to supervisors for review of findings.
- Used discretion and independent judgment in handling patient or physician received documents and routed to appropriate clinical staff, tracking progress of review and worked with physician reviewers to discuss clinical aspects of individual cases.
- Ensured compliance processes and procedures are adhered to for all state, federal and referral/intake regulatory requirements for Utilization Review.
Utilization Management Nurse
Dane Street
06.2018 - 02.2019
- Conducted assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
- Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
- Offered clinical expertise and serve as a clinical reference for non-clinical staff members.
- Managed essential clinical details within various medical management platforms.
- Responsible for being up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
- Apply clinical reasoning to determine the suitable evidence-based guidelines.
- Fostered efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.
Quality Assurance Nurse
Amedia Hospice
03.2017 - 01.2018
- Performed quality assurance review of clinical documentation to support Plan of Care for hospice patients.
- Utilization of ICD-10 coding and plan of care review as well as review of nurses notes prior to submission to CMS for payment.
- Educated and mentored staff members regarding documentation guidelines.
- Notified Director of Nursing of trends in documentation that required further review.
- Gathered data for QAPI reports and assisted supervisor with completion of reports.
Quality Assurance Nurse/Clinical Support LVN
Capitol Home Health
02.2017 - 01.2018
- Supported the Clinical Supervisor in ensuring that care is coordinated, services are delivered, and care managed appropriately.
- Assisted the Clinical Supervisor in supervising all clinical nursing staff (RNs, LVNs, HHAs) and provided training, mentoring and coaching as delegated. in regards to documentation of notes, led by the plan of care/OASIS for the patient.
- Expected to assist as a Field LVN, to cover staffing needs providing patient care, medication management and teaching to patients and families.
- Assisted Hospice Director with quality assurance of plan of care for hospice patients, ensuring timely documentation and return of nursing notes and documentation.
- Assisted Hospice Director with preparation and data retrieval for quarterly reports to CMS.
Education
Undergraduate - Nursing
Blinn College
Brenham10.1994
Skills
- Medical Record review/Quality Assurance
- Utilization Management
- Review of Coding
- Acute Care/Medical-Surgical Experience
- Long Term Acute Care
- Hospice
- Home Health
- Process Improvement
- EMR experience (Kinnser, HCHB, Forcura)
- Bilingual-Spanish
- Typing 69 wpm
Languages
Spanish
Professional Working
Timeline
Community Liaison
AccentCare
01.2023 - 04.2023
Pre Claim Review Auditor
AccentCare
08.2020 - 12.2022
Utilization Management Nurse
Nexus
04.2019 - 08.2019
Utilization Management Nurse
Dane Street
06.2018 - 02.2019
Quality Assurance Nurse
Amedia Hospice
03.2017 - 01.2018
Quality Assurance Nurse/Clinical Support LVN
Capitol Home Health
02.2017 - 01.2018
Undergraduate - Nursing
Blinn College
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