Kayla Isbell
Warrior,AL
Summary
Registered Nurse with over 10 years of healthcare experience, including 4+ years in clinical review and CMS-regulated medical record analysis. Expertise in auditing and validating documentation to ensure compliance, accuracy, and appropriate reimbursement across home health, hospice, and DME services. Proven ability to interpret complex medical records, identify fraud, waste, and abuse, and make independent determinations based on regulatory guidelines. Recognized as a subject matter expert with strong contributions to workflow improvement, staff mentorship, and CMS reporting.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Clinical Review Nurse
Nordian Healthcare Solutions
Fargo, ND
12.2021 - Current
- Perform comprehensive clinical audits and validation of medical records to ensure documentation supports appropriate coding, billing, and reimbursement in accordance with CMS guidelines
- Analyze claims involving durable medical equipment (DME), home health, and hospice services, ensuring compliance, accuracy, and completeness
- Apply clinical judgment and regulatory interpretation to make independent determinations regarding claim validity and documentation sufficiency
- Review cases involving fraud, waste, and abuse
- Serve as a Subject Matter Expert (SME) for the home health line of business
- Mentor and train new reviewers to improve consistency and accuracy
- Contribute to workflow improvement initiatives
- Assist in development of CMS reports
- Prepare detailed summaries of findings and provide recommendations for payment determinations and corrective action
- Identify and analyze provider billing patterns and trends
Registered Nurse
St. Vincent’s Hospital
05.2013 - 05.2017
- Provided perioperative nursing care and ensured patient safety
- Monitored patient status and supported clinical decision-making
- Trained and precepted new staff
Licensed Practical Nurse
Hanceville Nursing & Rehab
08.2010 - 01.2013
- Delivered direct patient care including medication administration and wound care
- Conducted clinical assessments and documentation
- Assisted in training staff
- Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.
Education
Associate of Applied Science - Nursing
Wallace State Community College
Hanceville, ALSkills
- Clinical Auditing & Validation
- Medical Record Review
- CMS Guidelines & Regulatory Compliance
- Fraud, Waste & Abuse Investigation
- CPT/HCPCS Coding Knowledge
- Documentation Accuracy & Reimbursement Integrity
- Home Health, Hospice & DME Review
- Quality Assurance & Process Improvement
- Independent Clinical Determination
- Staff Training & Mentorship
Certification
Registered Nurse – Alabama (Active)
Timeline
Clinical Review Nurse
Nordian Healthcare Solutions
12.2021 - Current
Registered Nurse
St. Vincent’s Hospital
05.2013 - 05.2017
Licensed Practical Nurse
Hanceville Nursing & Rehab
08.2010 - 01.2013
Associate of Applied Science - Nursing
Wallace State Community College