IRIS PYLES
Registered Nurse
FREDERICKSBURG,VA
Summary
Highly qualified, compassionate, dedicated registered nurse to deliver excellent quality, patient-centered care while continuing to grow as a healthcare provider.
Overview
7
7
years of professional experience
1
1
Certification
Work History
MDS Coordinator
Fredericksburg Health and Rehab Skilled Nursing Facility
05.2024 - Current
- Utilized exceptional communication and analytical skills in the planning, documentation, and submission of complied information
- Responsible for organizing and conducting daily PDPM meetings
- Collaborated with IDT to meet 5-Star quality measures
- Performed monthly Triple Check to ensure ICD10 code sequencing and accuracy, as well as PDPM code projections for end-of-month billing
- Ensured accurate HCC/Risk Adjustment coding on all residents, ensuring accurate risk adjustment factor (RAF) scores
- Knowledge of Medicaid 48 grouper reimbursement system.
Registered Nurse
Woodmont Skilled Nursing Facility
06.2022 - 12.2023
- Worked in collaboration with other healthcare professionals, residents, and their families
- Exercised critical thinking skills to deliver excellent, patient-centered care
- Identified and prioritized actions based upon patient care requirements
- Provided a safe, comfortable, and therapeutic patient environment.
MDS Support
Eastern Healthcare Group, Nassawadox Rehabilitation Skilled Nursing Facility
02.2022 - 01.2023
- Utilized standard coding guidelines and coding clinics to accurately and efficiently assign appropriate ICD10 codes, following all coding guidelines and Medicare/Medicaid regulations to ensure accurate reimbursement for multiple facilities in a remote position
- Performed concurrent and retrospective audits on residents to maximize reimbursement and reviewed clinical documentation to identify all appropriate coding based on CMS HCC/CDPS HHS models
- Abstracted and validated risk adjustment-specific codes
- Abstracted the appropriate ICD10 codes for mapping into PDPM to include PT/OT, SLP, Nursing, and NTA categories for improved patient outcomes
- Performed PDPM audits and provided education.
Lead MDS Coordinator
Fredericksburg Health and Rehab Skilled Nursing Facility
11.2021 - 12.2022
- Utilized exceptional communication and analytical skills in the planning, documentation, and submission of complied information
- Responsible for organizing and conducting daily PDPM meetings
- Collaborated with IDT to meet 5-Star quality measures
- Performed monthly Triple Check to ensure ICD10 code sequencing and accuracy, as well as PDPM code projections for end-of-month billing
- Ensured accurate HCC/Risk Adjustment coding on all residents, ensuring accurate risk adjustment factor (RAF) scores
- Knowledge of Medicaid 48 grouper reimbursement system.
Registered Nurse
Fredericksburg Health and Rehab Skilled Nursing Facility
03.2018 - 11.2021
- Worked in collaboration with other healthcare professionals, residents, and their families
- Devised patient-centered care plans
- Identified and prioritized actions based upon patient care requirements
- Provided a safe, comfortable, and therapeutic patient environment
- Ensured accurate ICD-10 coding/HCC coding on all new admissions.
Education
Master of Science in Nursing - Family Nurse Practitioner
Western Governors University
Salt Lake City, Utah03.2025
Bachelor of Science in Nursing - undefined
Western Governors University
Salt Lake City, Utah12.2020
Associate of Applied Science of Nursing - undefined
Eastern Virginia Career College
Fredericksburg, VA07.2017
Skills
- Policy and procedure development
- Care Plan Development
- Regulatory Compliance
- Interdisciplinary Team Collaboration
- Project management experience
- Statistical Analysis
- Team building
- Problem-Solving
- Analytical Skills
- Advanced data mining
- Excellent Communication
- Audit management
- Compliance Monitoring
- Quality Control
- Interpersonal Communication
Certification
- Bachelor of Science in Nursing, 12/01/20
- Registered Nurse, Multiple-State, 0001276254, 12/01/25
- BLS Certification, 03/01/25
- NAHQ (National Association for Healthcare Quality) Certification, 01/01/24
- Certified Risk Adjustment Coder, 09/01/22, 01915041
- Certified Risk Adjustment Coder Instructor, 07/01/23
Timeline
MDS Coordinator
Fredericksburg Health and Rehab Skilled Nursing Facility
05.2024 - Current
Registered Nurse
Woodmont Skilled Nursing Facility
06.2022 - 12.2023
MDS Support
Eastern Healthcare Group, Nassawadox Rehabilitation Skilled Nursing Facility
02.2022 - 01.2023
Lead MDS Coordinator
Fredericksburg Health and Rehab Skilled Nursing Facility
11.2021 - 12.2022
Registered Nurse
Fredericksburg Health and Rehab Skilled Nursing Facility
03.2018 - 11.2021
Master of Science in Nursing - Family Nurse Practitioner
Western Governors University
Bachelor of Science in Nursing - undefined
Western Governors University
Associate of Applied Science of Nursing - undefined
Eastern Virginia Career College
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