Jayme Medley
Registered Nurse
Nacogdoches,TX
Summary
Registered Nurse with 15+ years of combined experience in emergency nursing and Medicare documentation review. Proven ability to navigate high-pressure clinical settings and transition seamlessly into complex claims analysis for CMS compliance. Skilled in auditing documentation, identifying coding discrepancies, and applying CMS guidance across specialties. Leads provider education through the Targeted Probe & Educate (TPE) process to improve performance and reduce denial rates. Committed to accuracy, regulatory integrity, and supporting quality improvement
Overview
14
14
years of professional experience
Work History
Nurse Analyst
Wisconsin Physician Services
Remote, TX
11.2021 - Current
- Review Medicare claims across both Part A and Part B, including skilled nursing facility (SNF) stays, annual wellness visits, lipid panels, benign lesion destruction, and complex unlisted procedures requiring NOC code analysis
- Conduct detailed medical documentation reviews, ensuring alignment with CMS IOM guidance and medical necessity standards
- Prepare detailed rationales and citations for claim denials or approvals for providers, with recommended corrective actions
- Respond to provider inquiries with clarity and empathy, often assisting with template revisions, or CMS citation clarification.
- Track and log claim-level error rates across TPE rounds, maintaining compliance with CMS's 20% error threshold policy
- Collaborate cross-functionally with internal teams and providers to streamline communication and support provider education
- Create provider-facing education packets and participate in live educational teleconferences to review errors, clarify CMS documentation expectations, and reduce future denials
Elementary School Nurse
Woden Independent School District
Woden, TX
08.2021 - 05.2023
- PRN
- Established strong relationships with parents, ensuring timely communication regarding their child''s health status or needs.
- Coordinated with local healthcare professionals to ensure access to necessary services for students in need of specialized care.
- Enhanced student health by providing comprehensive medical care and addressing various health issues.
Registered Nurse, Emergency Department
Nacogdoches Medical Center
Nacogdoches, TX
02.2014 - 10.2021
- Teamed on trauma and emergency interventions involving serious head injuries, gunshot wounds, and thoracic trauma.
- Demonstrated strong clinical reasoning skills when assessing patients'' conditions, initiating appropriate interventions, and escalating concerns to physicians as needed.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Promoted a safe and supportive environment for both patients and staff members by adhering to infection control protocols, maintaining equipment, and following safety guidelines.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
Registered Nurse, Emergency Department
CHI St. Luke's Health Memorial Lufkin
Lufkin, TX
06.2011 - 10.2014
- Provided direct patient care in a fast-paced emergency room setting, assessing and triaging patients based on the severity of their condition
- Administered medications, treatments, and interventions as ordered by physicians to stabilize patients, and alleviate symptoms
- Monitored vital signs, assessed changes in patient status, and promptly reported any abnormalities or concerns to the attending physician
- Managed multiple critical cases simultaneously, while ensuring accurate documentation of patient information and treatment provided
- Responded efficiently during emergencies, such as cardiac arrests or trauma situations, by initiating lifesaving interventions following established protocols
Education
Associate of Science - Nursing
Angelina College
Lufkin, TX06-2011
Skills
Clinical documentation review
Critical thinking
Quality improvement initiatives
Teamwork and collaboration
Problem-solving
Time management
Multitasking Abilities
Self motivation
Effective communication
Active listening
Organizational skills
Attention to detail
Timeline
Nurse Analyst
Wisconsin Physician Services
11.2021 - Current
Elementary School Nurse
Woden Independent School District
08.2021 - 05.2023
Registered Nurse, Emergency Department
Nacogdoches Medical Center
02.2014 - 10.2021
Registered Nurse, Emergency Department
CHI St. Luke's Health Memorial Lufkin
06.2011 - 10.2014
Associate of Science - Nursing
Angelina College
Similar Profiles
Lisa WalsethLisa Walseth
Vice President of Operations at Wisconsin Physician ServicesVice President of Operations at Wisconsin Physician Services
Emily CavinderEmily Cavinder
Claims Rep Lead at Wisconsin Physician ServicesClaims Rep Lead at Wisconsin Physician Services
Quanita PayneQuanita Payne
Claims Rep 1 at Wisconsin Physician ServicesClaims Rep 1 at Wisconsin Physician Services
Brenda ListerBrenda Lister
RESEA Case Manager at Dynamic Workforce SolutionsRESEA Case Manager at Dynamic Workforce Solutions
Rebecca TindallRebecca Tindall
Licensed Nursing Home Administrator at Kennedy Health and RehabLicensed Nursing Home Administrator at Kennedy Health and Rehab