Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

KAREN WENDELL

Farmingdale,New York

Summary

Team-oriented professional prepared to take on leadership responsibilities with focus on driving results and fostering collaboration. Proven success in managing teams, overseeing project execution, and adapting to dynamic work environments. Known for reliability, flexibility, and strong organizational skills, ensuring seamless team operations and achievement of goals.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Team Lead/Nurse Auditor / Revenue Recovery Consultant II

JZANUS CONSULTING INC
06.2021 - Current
  • Performs detailed reviews for Medicare and Medicaid bills in conjunction with the patient’s medical record ensuring that every billable item, procedure, pharmaceutical and medical supply was captured on the revised itemized bill
  • Creates a detailed report with correct and additional missing items off the itemized bill
  • Assesses denials of chargeable items received from IPRO, Empire, Optum, Equian, and Medreview and opens an investigation in the medical record to find supporting clinical information to formulate and coordinate a formal appeal
  • Appeals denied length of stay by finding the acuity of the patient’s illness and supporting clinical- criteria based documentation in the medical record
  • Prioritizes work in a timely manner to ensure responses are submitted in the required timeframes
  • Identifies, reviews, and monitors findings on denials and cost outliers to avoid future loss of revenue to our clients
  • Trains and provides education to colleagues and support staff

Clinical Denial Appeals Specialist

NORTHWELL HEALTHCARE SYSTEM
11.2017 - 06.2021
  • Company Overview: FINANCE REVENUE CYCLE
  • Reviewed coordinates utilize reviews concurrently and retrospectively to prevent denials from managed care and third-party reviewers for inpatient admissions.
  • Sorted, reviewed, and evaluated cases denied by Third party payers and determined follow through for first level appeals within contractual or appropriate timeframes.
  • Determined whether all relevant clinical information has been submitted to the insurance carrier
  • Identified if cases warrant review by a physician advisor
  • Wrote first and second level insurance appeal letters
  • Maintained data tracking systems and provides reports to patient accounts, director of denial prevention, and physician advisors
  • Participated in departmental continuous quality improvement activities and committees
  • Promoted staff development and education
  • Ensured compliance with HIPAA regulations to include confidentiality

SRG NURSE-Volunteered to be deployed to the Special Response Group

NORTHWELL HEALTHCARE SYSTEM
04.2020 - 09.2020
  • Company Overview: SPECIAL RESPONSE GROUP COVID
  • Employed combination of communication skills and related experience to provide for adaptation in an ever-changing environment
  • Utilized clinical experience to guide colleagues and patients to the appropriate level of care
  • Established a department with limited resources to aid in the pandemic of the coronavirus in the New York region

Nurse Case Manager

NORTHWELL HEALTHCARE SYSTEM
05.2014 - 11.2017
  • Company Overview: QUALITY MANGEMENT/CARE MANAGEMENT
  • Ensured managed care reviews are up to date and accurately reflect patient's acute needs and clinical progress assesses each patient physically, psychosocially, and financially served as a patient liaison-assessing, planning, implementing, and evaluating patient in collaboration with the health care team
  • Worked with acute care and traumatic brain injury patients
  • Communicated with administration and insurance companies regarding utilization issues and discharge plan
  • Identified discharge needs and facilitates plan to ensure the best outcome for patient
  • Case Management, PRI, and Screen Certified
  • Interacted with physicians, nursing staff, case management and medical coding staff to facilitate modifications to clinical documentation
  • Provided educational programs as required

Clinical Documentation Specialist

NORTH SHORE LONG ISLAND JEWISH HEALTHCARE SYSTEM
09.2008 - 05.2014
  • Company Overview: Worked within numerous hospitals throughout the healthcare system
  • Improved quality and completeness of clinical documentation in the medical record
  • Interacted with physicians, nursing staff, case management and medical coding staff to facilitate modifications to clinical documentation
  • Provided educational programs as required
  • Served as a resource to Physicians, Case Managers and other key professional staff regarding DRG/coding clarification
  • Compiled and provided timely statistical reports
  • Worked with medical records, finance, and physician groups to develop systems to facilitate complete documentation for data reporting

Registered Nurse Cardiology

NORTH SHORE LONG ISLAND JEWISH HEALTHCARE SYSTEM
05.2002 - 09.2008
  • Assessed patients’ physiological and psychosocial health status
  • Explained policies and procedures to patients and significant others
  • Answered questions correctly and courteously
  • Determined mobility, sensory deficits, prostheses use and skin condition and adjusted plan of care as appropriate
  • Determined coping mechanisms, knowledge level and ability to comprehend
  • Collaborated with health care team members in carrying out treatment regimen
  • Identified cultural and ethnic requirements to reduce anxiety and ensure patient satisfaction
  • Participated in planning for discharge and coordinated referrals as appropriate
  • Provided emotional support to patients and significant others
  • Acted as preceptor and charge nurse
  • Utilize leadership skills/clinical judgment in coordinating patient care and directing /delegating activities of the patient care unit team

Education

Bachelor of Science - Nursing

Molloy College
Rockville Centre, NY
01.1999

Bachelor of Science - Business Administration

Long Island University C.W. Post
05-1989

Skills

  • Attention to detail
  • Customer focus
  • Coaching and mentoring
  • Performance monitoring
  • Performance improvement
  • Quality control
  • Production monitoring
  • Employee evaluation
  • Relationship building
  • Talent acquisition
  • Deadline management
  • Employee training
  • Task delegation
  • Strategic planning
  • Workflow management

Certification

  • Registered Professional Nurse in the State of New York 511725
  • PRI certified

Timeline

Team Lead/Nurse Auditor / Revenue Recovery Consultant II

JZANUS CONSULTING INC
06.2021 - Current

SRG NURSE-Volunteered to be deployed to the Special Response Group

NORTHWELL HEALTHCARE SYSTEM
04.2020 - 09.2020

Clinical Denial Appeals Specialist

NORTHWELL HEALTHCARE SYSTEM
11.2017 - 06.2021

Nurse Case Manager

NORTHWELL HEALTHCARE SYSTEM
05.2014 - 11.2017

Clinical Documentation Specialist

NORTH SHORE LONG ISLAND JEWISH HEALTHCARE SYSTEM
09.2008 - 05.2014

Registered Nurse Cardiology

NORTH SHORE LONG ISLAND JEWISH HEALTHCARE SYSTEM
05.2002 - 09.2008

Bachelor of Science - Nursing

Molloy College

Bachelor of Science - Business Administration

Long Island University C.W. Post
KAREN WENDELL