JOAN ESTELLE BUNYI

ASSIGNED TO: PRESTIGE NURSING CARE & REHABILITATION CENTER (Formerly Citadel at Kingsbridge)

Address: 3400 Cannon Place, Bronx, NY 10463

• Delivered comprehensive nursing care and clinical supervision in long-term care and rehabilitation settings.
• Analyzed patient conditions and documented changes, relaying critical information to physicians and nursing leadership for informed decision-making.
• Performed skilled nursing procedures, including medication administration, wound care, catheter management, and tube feedings, to support optimal patient health.
• Facilitated collaboration among nursing staff, physicians, therapists, patients, and family members to enhance care delivery.
• Analyzed and updated patient care plans, focusing on improving quality of care and fostering continuity in treatment.
• Provided comprehensive guidance to patients and families to enhance understanding of treatment plans and medication management.
• Implemented and monitored adherence to infection control standards and safety protocols to ensure regulatory compliance.
• Managed nursing assistants to ensure efficient daily operations and optimal patient care.
• Implemented evidence-based fall prevention strategies, resulting in a significant decrease in patient falls within the unit.
• Demonstrated expertise in wound management techniques resulting in accelerated healing times for patients with complex wounds or pressure injuries.
• Conducted regular assessments of patient conditions, adjusting care plans as necessary for optimal outcomes.
• Monitored patient reactions after administering medications and IV therapies.

• Reviewed US-based medical records and clinical documentation to support appeals of denied insurance claims. (HCA hospitals in Florida)
• Prepared evidence-based appeal letters utilizing established medical guidelines and standards of care.
• Collaborated with physicians and healthcare providers to obtain supporting clinical documentation.
• Evaluated diagnoses, treatment plans, and patient outcomes to support medical necessity determinations.
• Maintained detailed records and ensured timely submission of appeals.

• Conducted US-based pre-certification reviews, concurrent reviews, and authorization determinations for inpatient and outpatient services.
• Evaluated medical necessity for surgical procedures, diagnostic testing, specialty services, and hospitalization requests.
• Reviewed clinical documentation utilizing ACOEM, ODG, and established medical guidelines.
• Collaborated with physicians, medical directors, case managers, and healthcare providers regarding patient care plans.
• Facilitated discharge planning and transitions of care across the healthcare continuum.
• Communicated authorization decisions and coordinated follow-up activities with providers and patients.
• Ensured compliance with healthcare regulations, accreditation standards, and organizational policies.
• Utilized Interqual, MCG care guidelines to check medical necessity

• Delivered exceptional customer service to American Express US-based customers while handling complex account inquiries and dispute resolution.
• Assisted customers with account services and resolved fraud concerns and benefit inquiries, promoting customer satisfaction.
• Gathered and verified customer information, ensuring confidentiality and accuracy to enhance client trust.
• Cultivated strong communication, problem-solving, and relationship-building skills to foster positive client interactions.

• Investigated and analyzed suspicious US-based financial transactions, identifying potential fraud cases to enhance security measures.
• Contacted customers and merchants to verify account activity, effectively mitigating risk and ensuring compliance.
• Prepared detailed reports and maintained accurate documentation.
• Utilized analytical and communication skills to resolve complex account issues, improving customer satisfaction and trust.
• Analyzed risk data to identify trends and potential impacts on business operations.

• Assisted US-based customers with financial products, insurance enrollment, lending services, and account inquiries, ensuring accurate and timely responses to enhance customer satisfaction.
• Assisted US-based customers with financial products, insurance enrollment, lending services, and account inquiries.
• Delivered exceptional customer service in high-volume call center environments, resolving inquiries effectively to maintain service quality.
• Demonstrated strong communication, documentation, and problem-solving skills.