Karen Garrett
Hot Springs,AR
Summary
Adept UM Lead/Denial Specialist/Appeals and Grievances Coordinator with a proven track record at, excelling in claims analysis and dispute resolution. Mastered complex denial cases, significantly reducing denial rates by implementing strategic improvements. Renowned for detail orientation and collaborative efforts, ensuring regulatory compliance and enhancing process efficiency.
Overview
21
21
years of professional experience
1
1
Certification
Work History
UM Lead/Denial Specialist/Appeals and Grievances Coordinator
St. Vincent Hospital
Hot Springs National Park, AR
11.2013 - Current
- Collaborated with internal departments and external stakeholders to troubleshoot problems relating to denials.
- Participated in meetings with physicians, nurses, coders, billing personnel., regarding denial prevention initiatives.
- Conducted detailed research on complex denial cases to determine the root cause and appropriate appeal strategy.
- Worked closely with clinical staff to obtain necessary documentation to support appeal submissions.
- Monitored trends in claim denials to identify opportunities for process improvement and training.
- Prepared and submitted appeal letters and necessary documentation to overturn unjustified denials.
RN/Nurse Manager
St Vincent Urology Clinic
Hot Springs, AR
07.2003 - 11.2024
- Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
- Assisted doctors during medical procedures.
- Trained and mentored new RNs on best practices, hospital policies and standards of care.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
Education
Master of Science - Nursing
Grand Canyon University
Phoenix, AZ05-2018
Skills
- Claims analysis
- Utilization review
- Appeals processing
- Detail orientation
- Multi-tasking
- Dispute Resolution
- Regulatory Compliance
Accomplishments
- Service Hero Award - March 2023
Certification
- Registered Nurse
- BLS certified
Timeline
UM Lead/Denial Specialist/Appeals and Grievances Coordinator
St. Vincent Hospital
11.2013 - Current
RN/Nurse Manager
St Vincent Urology Clinic
07.2003 - 11.2024
- Registered Nurse
- BLS certified
Master of Science - Nursing
Grand Canyon University
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