Kathy Matthews
Irmo,SC
Summary
Skilled nursing professional with strong background in patient care coordination and healthcare management. Demonstrates expertise in clinical assessment, discharge planning, and patient advocacy. Known for fostering team collaboration, adapting to evolving needs, and delivering meaningful outcomes. Equipped with excellent communication skills, critical thinking, and ability to navigate complex healthcare systems.
Overview
17
17
years of professional experience
Work History
Clinical Payment Resolution Specialist
Trinity-Health
03.2021 - 04.2025
- Reviewed denied claims against documentation to identify clinical rationale, unmet criteria and gaps prohibiting payment.
- Achieved significant cost savings by renegotiating claims, resulting in 3m in collected denials multiple years.
- Analyzed appeal requests to ensure compliance with regulatory standards and organizational policies.
- Implemented process improvements that reduced turnaround time for appeal resolutions.
- Negotiated settlements successfully with external parties involved in claim disputes while maintaining professional demeanor at all times.
Clinical Case Manager
Priority Health Group
08.2013 - 10.2020
- Managed complex care population to optimize outcomes and resource utilization.
- Reduced hospital readmission rates by conducting thorough patient assessments and providing appropriate resources and support for post-discharge care.
- Improved patient outcomes by developing and implementing comprehensive case management plans.
- Assessed individual barriers to optimal health outcomes such as socioeconomic factors or access limitations, working diligently to address these challenges through tailored interventions.
- Assisted with outreach and engagement services to engage clients and maintain working relationships.
- Utilized evidence-based practices to inform decision-making processes and optimize case management outcomes for diverse patient populations.
Registered Nurse Case Manager- Hospice
Spectrum Health Hospice
08.2008 - 09.2013
- Managed complex caseloads effectively, prioritizing tasks based on patient acuity levels.
- Maintained accurate documentation of patient interactions, assessments, interventions, and responses to care.
- Served as a liaison between patients, families, and healthcare providers to ensure seamless delivery of hospice services.
- Collaborated with physicians to optimize medication regimens for symptom control in terminally ill patients.
- Promoted an environment conducive to open communication among staff members regarding complex cases or challenging situations.
Education
Associate of Arts - Communications
Grand Rapids Community College
Grand Rapids, MIAssociate of Science - Nursing
Excelsior College
Albany, NYSkills
- Assertiveness
- Document preparation
- Information collection
- Deductive reasoning
- Legal expertise
- Attention to detail
- Critical thinking
- Organizational skills
- Legal research
- Written communication
Timeline
Clinical Payment Resolution Specialist
Trinity-Health
03.2021 - 04.2025
Clinical Case Manager
Priority Health Group
08.2013 - 10.2020
Registered Nurse Case Manager- Hospice
Spectrum Health Hospice
08.2008 - 09.2013
Associate of Arts - Communications
Grand Rapids Community College
Associate of Science - Nursing
Excelsior College