Kristen Clark
Kennewick,WA
Summary
Driven by a results-focused approach, I leveraged strong clinical judgment and compassion at Optum to enhance claim processing efficiency and patient satisfaction. My background in nursing and expertise in electronic medical records and complex problem-solving significantly improved outcomes and streamlined operations, demonstrating a commitment to excellence and continuous improvement in healthcare.
Overview
19
19
years of professional experience
Work History
Medical Claims Analyst
Optum
10.2022 - Current
- Conducted comprehensive audits to identify inconsistencies and irregularities in medical claims data.
- Selected for Clinical Point UAT Testing as a Referral/Triage MCA
- Enhanced claim processing efficiency by implementing automated workflows and streamlining procedures.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
- Increased departmental accuracy by implementing quality control measures for claim submissions and reimbursements.
- Mentored junior analysts within the team to promote professional growth opportunities amongst peers.
- Demonstrated a commitment to continuous improvement by actively seeking out opportunities for process optimization within the Medical Claims Analyst role.
- Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Generated, posted and attached information to claim files.
Per Diem Registered Nurse
Hanford Home Health
09.2024 - Current
- Utilized critical thinking skills to prioritize nursing interventions based on patients' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Participated in ongoing professional development opportunities to stay current on best practices in nursing care delivery.
- Streamlined documentation processes by maintaining accurate electronic medical records and updating patient charts regularly.
Registered Nurse
Pro Case Management
11.2014 - 02.2017
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
Registered Nurse
Benton County Sheriff's Office
08.2006 - 10.2014
- Performed triage on incoming patients and determined severity of injuries and illnesses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Enhanced patient care by conducting thorough assessments and promptly addressing critical needs.
- Managed emergency situations effectively, performing life-saving interventions as necessary.
- Upheld ethical nursing standards in all interactions with patients, colleagues, corrections officers, and other stakeholders within the correctional setting.
- Demonstrated cultural competence while working with diverse populations, facilitating trust-building between staff members and inmates from various backgrounds.
- Optimized resource utilization by monitoring supply levels and reordering medications as needed, minimizing waste and saving costs for the institution.
- Enhanced patient care by conducting thorough assessments and developing tailored treatment plans for inmates.
- Conducted ongoing evaluations of inmate needs, adjusting care plans accordingly for improved health outcomes.
- Maintained accurate medical records for legal compliance, contributing to a well-organized healthcare system within the correctional facility.
- Stabilized prisoners suffering from falls, stab wounds or other injuries prior to hospital transfer.
- Administered different therapies and medications in line with physician orders and treatment plan.
- Managed patients recovering from medical or surgical procedures.
Licensed Practical Nurse
Benton County Sheriff's Office
12.2005 - 08.2006
- Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
- Cared for wounds, provided treatments, and assisted with procedures.
- Assisted with admissions, appointments, transfers, and discharges.
- Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.
- Administered medications and injections to patients.
Education
Associate of Applied Science - Nursing
Columbia Basin College
Pasco06.2006
Skills
Microsoft, windows, Clinical Point, OnBase, SSRS use
Care Planning
Complex Problem-Solving
Patient confidentiality
Electronic Medical Records
Home Health Care
Long-Term Care
Medication and IV administration
Strong Clinical Judgment
Documentation and Charting
Compassion and Empathy
Research utilization
Additional Information
I owned a very successful Mobile Boutique from October 2014 - February 2023
Timeline
Per Diem Registered Nurse
Hanford Home Health
09.2024 - Current
Medical Claims Analyst
Optum
10.2022 - Current
Registered Nurse
Pro Case Management
11.2014 - 02.2017
Registered Nurse
Benton County Sheriff's Office
08.2006 - 10.2014
Licensed Practical Nurse
Benton County Sheriff's Office
12.2005 - 08.2006
Associate of Applied Science - Nursing
Columbia Basin College