Karen Hayes BSN, RN
New Johnsonville,TN
Summary
Patient-oriented Nurse with over 12 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Prebill Denials RN-Team Lead
Parallon Healthcare
01.2023 - Current
- Develop and implement strategies to optimize the prebill denial process and reduce the number of denials for inpatient hospitalizations for over 20 HCA Hospitals across the United States.
- Collaborate with other team leads to identify process improvement opportunities and implement changes to increase overall productivity and efficiency.
- Collaborate with workman's comp adjusters and case managers to ensure all documents are available for surgical claims.
- Collaborate with IT department to develop and implement technology solutions that streamline the prebill denial process.
- Analyze and evaluate trends in prebill denials to identify root causes and implement solutions.
- Design and deliver educational sessions on topics
- Identifying training needs and providing guidance to team members on best practices for prebill denial management.
- Train and mentor new team members on the prebill denial process and best practices to minimize denials and improve efficiency.
- Resolve problems, improve operations and provide exceptional service in a management role as a team lead.
Clinic Nurse
Fast Pace Urgent Care
10.2023 - Current
- Assess and triage patients presenting with a variety of acute illnesses and injuries, prioritizing care based on severity and urgency
- Perform rapid and accurate patient assessments, including vital signs, medical history, and chief complaints, to facilitate timely treatment and interventions
- Administer medications, treatments, and procedures in accordance with clinic protocols and physician orders, ensuring patient safety and comfort
- Assist in educating patients and their families on treatment plans, medications, follow-up care, and preventive measures, promoting patient understanding and compliance
- Assist in managing and organizing medical supplies and equipment inventory
- Assist with coordinating and facilitating patient referrals to other healthcare providers and specialists
- Assist with DOT physicals including vision screening, urine drug screening, and blood alcohol testing.
- Communicate with healthcare team members to plan, implement and enhance treatment strategies.
Prebill Denials Registered Nurse
Parallon Healthcare
09.2019 - 01.2023
- Collaborate with the billing team to reconcile any prebill denials and ensure accurate and timely submission of claims
- Communicate with insurance companies and healthcare providers to resolve prebill denials and ensure timely payment for procedures
- Collaborate with the coding team to ensure accurate assignment of CPT codes for outpatient surgical accounts
- Conducted thorough reviews of patient medical records to evaluate the appropriateness, necessity, and efficiency of healthcare services and treatments.
Cardiac Clinical Reviewer
Evicore
03.2018 - 09.2019
- Communicated effectively with staff, patients, and insurance companies via email and telephone.
- Reduced errors in medical documentation through diligent attention to detail and consistent follow-up on discrepancies.
- Carefully review written and obtain verbal clinical information to perform medical necessity review while providing superior customer service in a timely and accurate manner
- Assist callers with verifying the right testing is ordered at the right time to promote effective and affordable quality of care to clients
- Schedule peer to peer reviews to ensure correct testing is completed.
- Ensured compliance with regulatory requirements through careful adherence to established guidelines and protocols.
Critical Care Float Nurse
HCA Tristar Horizon Medical Center at Dickson, TN
11.2012 - 03.2018
- Collaborate with the interdisciplinary team to develop and implement evidence-based nursing care plans for patients in labor and delivery, NICU, and ICU settings.
- Educated family members and caregivers on patient care instructions.
- Assist in the development and implementation of training programs for new nursing staff and provide ongoing mentorship and support.
- Implemented evidence-based nursing practices, resulting in improved patient satisfaction rates and overall quality of care.
- Developed strong rapport with patients and families by demonstrating empathy, active listening skills, and cultural sensitivity during care provision.
- Collaborated closely with physicians to evaluate patient progress and adjust treatment plans as needed to achieve optimal outcomes.
Education
BACHELOR OF SCIENCE: NURSING -
WESTERN GOVERNORS UNIVERSITY
04.2017
ASSOCIATES OF SCIENCE: NURSING -
JACKSON STATE COMMUNITY COLLEGE
Jackson, TN05.2012
Skills
- Analytical skills
- Quality assurance
- Training and education
- Data analysis and process improvement
- Multidisciplinary Team Collaboration
- Case Management
- Intake assessments
- Diagnostic Test Ordering and Interpretations
- Clear Patient Communication
- Healthcare Referral Management
- ICD-10 and CPT Coding
- Microsoft Office
Certification
- Registered Nurse (RN), TN Compact License # 188176, 2012
- Department of Transportation UDS and BAT Certified, 01/04/24 - 01/04/29
- Basic Life Support, 10/01/23 - 10/01/25
Timeline
Clinic Nurse
Fast Pace Urgent Care
10.2023 - Current
Prebill Denials RN-Team Lead
Parallon Healthcare
01.2023 - Current
Prebill Denials Registered Nurse
Parallon Healthcare
09.2019 - 01.2023
Cardiac Clinical Reviewer
Evicore
03.2018 - 09.2019
Critical Care Float Nurse
HCA Tristar Horizon Medical Center at Dickson, TN
11.2012 - 03.2018
BACHELOR OF SCIENCE: NURSING -
WESTERN GOVERNORS UNIVERSITY
ASSOCIATES OF SCIENCE: NURSING -
JACKSON STATE COMMUNITY COLLEGE
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