KANESIA QUICKSEY
Pelham
Summary
Results-driven LPN with 20+ years of clinical and administrative healthcare experience in acute care, long-term care, and payer-side operations. Specializes in prior authorization, appeals, and HEDIS abstraction, with a solid understanding of CMS, ERISA, and NCQA requirements. Currently pursuing a Bachelor’s in Healthcare Administration as a Registered Nursing student (Graduation: Dec 2025). Dedicated to improving patient outcomes and health system performance through evidence-based decision-making, quality improvement, and patient advocacy.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Appeals Processing Senior Representative
Cigna Healthcare
01.2018 - Current
- Manage 50–70 appeals and prior authorizations weekly, maintaining 99% timeliness.
- Collaborate with MDs and clinical teams to determine medical necessity and coverage.
- Recognized with 2023 "Excellence in Quality" Award for superior service and accuracy.
- Reduced case backlog by 30% by developing a real-time tracking system in Excel.
Licensed Practical Nurse
Kirkwood by the River
01.2017 - 01.2021
- Provided high-quality post-op and chronic disease management for up to 24 residents.
- Spearheaded fall-prevention program, decreasing falls by 18% within one year.
- Oriented 8 newly hired LPNs in EMR usage, wound care, and IV protocol compliance.
Licensed Practical Nurse (Med-Surg)
Brookwood Baptist Hospital
01.2002 - 01.2017
- Delivered bedside care for surgical-medical patients with a 5:1 nurse-patient ratio.
- Reinforced CLABSI prevention policies—unit achieved zero cases for 18 consecutive months.
- Participated in the Quality Improvement Council to revise clinical reconciliation policies.
Director / LPN
Blackwell’s Way Group Home
01.2010 - 01.2014
- Oversaw 25-member interdisciplinary staff and a $500,000 annual budget, with 100% regulatory compliance.
- Collaborated with psychiatrists to develop behavior plans, reducing incident rates by 25%.
- Introduced electronic MAR system, improving documentation accuracy by 98%.
Education
A.S. - Nursing
01.2025
B.S. - Healthcare Administration
Rasmussen University
01.2020
Diploma - Practical Nursing
Bevill State Community College
Jasper, AL01.1998
Skills
- Prior Authorizations & Appeals (URAC / NCQA)
- Medicare, Medicaid, & Commercial Insurance
- HEDIS Data Abstraction & Quality Metrics
- Clinical Review & Regulatory Compliance (CMS, ERISA)
- EHR Systems: Epic, Cerner, PointClickCare
- Remote/Telehealth Clinical Operations
- Case Management & Patient-Centered Education
- Workflow Improvement & KPI Dashboards
- Team Training & Preceptor Mentorship
Websites
Certification
- BLS – American Heart Association
- CPI – Crisis Prevention & Intervention
- IV Therapy Certified
Timeline
Appeals Processing Senior Representative
Cigna Healthcare
01.2018 - Current
Licensed Practical Nurse
Kirkwood by the River
01.2017 - 01.2021
Director / LPN
Blackwell’s Way Group Home
01.2010 - 01.2014
Licensed Practical Nurse (Med-Surg)
Brookwood Baptist Hospital
01.2002 - 01.2017
A.S. - Nursing
B.S. - Healthcare Administration
Rasmussen University
Diploma - Practical Nursing
Bevill State Community College
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