
Experienced and detail-oriented nursing professional with a strong foundation in clinical documentation, care coordination, and regulatory compliance across diverse healthcare settings. Skilled in reviewing medical records for accuracy, medical necessity, and adherence to payer policies. Adept at collaborating with interdisciplinary teams to ensure appropriate utilization of services while upholding patient-centered standards of care. Proficient in EMR systems, ICD/CPT coding knowledge, and navigating Medicare/Medicaid and private payer guidelines. Committed to promoting quality outcomes through evidence-based decision-making and analytical review.
Clinical assessment and critical thinking
Chart auditing and documentation review
Utilization management and care coordination
Strong knowledge of Medicare/Medicaid guidelines and payer policies
Broad clinical knowledge across the lifespan
Interdisciplinary care coordination
Nursing staff leadership