Janette Taylor
Summary
Experienced and results-oriented Registered Nurse with clinical, coding, managerial, project management, and subject matter expert experience in the healthcare, coding, and insurance industry (Medicare, Medicaid, and Commercial Payers). Highly organized and skilled in written and verbal communication, as well as state Medicaid, federal and Centers for Medicare and Medicaid policy research. Able to effectively self-manage during independent projects, as well as collaborate as part of a productive team.
Overview
40
40
years of professional experience
1
1
Certification
Work History
Subject Matter Expert/Project Manager
Empower A.I.
11.2018 - Current
- Subject Matter Expert for Payment Error Rate Measurement (PERM) audits to measure improper payments in Medicaid and CHIP for all states
- Work directly with the Center for Medicare and Medicaid Services (CMS)
- Review Medicaid fee-for-service claims to assure payments meet statutory, regulatory, and administrative requirements
- Research federal, state, Medicare, and state Medicaid policies
- Responsible for Quality Assurance and utilization review
- Responsible for review of correct CPT, HCPCS, ICD-10, state local codes and DRG coding.
RN Senior Clinical Analyst II
Cotiviti
07.2009 - 11.2018
- Analyzed, researched, and reported statistical data from professional, facility, and pharmacy claims for compliance, claims coding and editing, and utilization of services billed to Medicare, Medicaid, and commercial insurance carriers
- Reviewed appropriate CPT, HCPCS, and ICD-10 coding
- New client on-boarding and training
- Researched and identified erroneous billing patterns
- Completed appeals and medical record reviews
- Researched and followed federal, state, Medicare, and Medicaid healthcare regulations, policies, coverage guidelines and the corresponding payments of services rendered/billed.
Sr. Nurse Healthcare Reviewer
Principal Financial Group
08.1999 - 07.2009
- Prospective, concurrent, and retrospective reviews of medical, dental and vision records and claims to administer appropriate health care benefits according to policy provisions
- Completed prior authorizations, reviewed CPT
- HCPCS, ICD-9, and DRG coding
- Medicare, Medicaid, and commercial carrier policy research.
Director of Emergency Department
Pioneer Valley Hospital
09.1983 - 08.1999
- Director of Emergency Department, Urgent Care, Cardiac Cath Lab, and GI Endoscopy Lab
- Responsible for staffing, personnel management, disaster preparedness, Trauma Registry, BLS Training Center Coordinator, Quality Improvement, policies and procedures, and multiple other duties
- Liaison for physicians, patients, visitors, outside agencies, and the community.
Education
MBA -
University of Phoenix
01.1996
BSN -
University of Utah
01.1988
RN (Associate Degree) -
Weber State University
01.1983
Skills
- Registered Nurse
- Certified Professional Coder
- Microsoft Office Suite proficient
- Project Management
- Communication Skills
- Management Skills
- MediRegs
- MCG (Milliman)
- Leadership Skills
- Data Analysis
- Idea Development and Brainstorming
- Process Improvement
Certification
- Nurse License, Utah Registered Nurse 175526-3102
- Certified Professional Coder, 01162082, 2011
References
- Carol Nazarro, RN, 518-681-9155
- Tamara Malone, RN, MSN, 801-963-6593
Timeline
Subject Matter Expert/Project Manager
Empower A.I.
11.2018 - Current
RN Senior Clinical Analyst II
Cotiviti
07.2009 - 11.2018
Sr. Nurse Healthcare Reviewer
Principal Financial Group
08.1999 - 07.2009
Director of Emergency Department
Pioneer Valley Hospital
09.1983 - 08.1999
MBA -
University of Phoenix
BSN -
University of Utah
RN (Associate Degree) -
Weber State University
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