Kristi Wiggins
Little Rock,MS
Summary
Accomplished Registered Nurse with extensive experience at Trinity Health, specializing in denial management and appeals processing, demonstrating expertise in electronic medical records and effective communication to ensure accurate claims resolution.
Overview
19
19
years of professional experience
Work History
Registered Nurse
Trinity Health
Livonia, Michigan
07.2021 - Current
- Currently working as a Remote Payment Resolution Specialist performing provider appeals for denied insurance claims.
- Review EOB’s, denial letters, remittance advices, and account notes to determine cause of denial.
- Call payer if cause of denial is unclear.
- Use clinical expertise along with clinical guidelines (Milliman Care Guidelines, InterQual Criteria, Case Management notes, and Peer to Peer information) to determine if appeal is warranted or if claim needs to be adjusted for a contractual adjustment, expected denial, etc.
- Perform a second level appeal if warranted.
Remote Nurse Charge Auditor
Adreima/Nthrive/Savista
05.2013 - 07.2021
- Conducted line-by-line audits of inpatient and outpatient services to ensure accurate billing.
- Drafted various documents including audit guidelines, client reports, and process presentations.
- Utilized Meditech, Cerner, Epic, and Microsoft Office Suite for documentation and reporting.
- Managed appeal and denial letters for insurance companies, enhancing claims resolution efficiency.
- Executed observation injection and infusion audits to verify compliance with regulations.
Field Nurse / Home Care Coordinator
Sta-Home Health and Hospice
07.2012 - 05.2013
- Served as Field Nurse for Home Health for five months before promotion to Home Care Coordinator.
- Conferred with clinical personnel regarding recertification to confirm Medicare eligibility.
- Ensured Medicare compliance while delivering coordinated patient care through interdisciplinary care development and evaluation.
- Communicated changes in care plans to physicians, patients, caregivers, and field nurses.
Registered Nurse
Anderson’s Regional Medical Center
Meridian, MS
05.2006 - 07.2012
- Provided critical care nursing at Anderson’s for over three years, including four months as Charge Nurse on night shift.
- Managed high-stress situations effectively while prioritizing patient safety and care quality.
- Communicated promptly with physicians regarding significant changes in patient acuity levels.
- Executed doctors’ orders, including testing, medical procedures, and consultations without delay.
- Assisted in multiple invasive procedures such as central lines and intubation to enhance patient outcomes.
- Led teams during cardiopulmonary arrests utilizing ACLS protocols to ensure optimal emergency response.
- Worked Case Management and Utilization Review 10/2007-12/2010
- Documented patient progress notes accurately and efficiently in the electronic medical record system.
- Instructed patients on proper self-care techniques at home following discharge from the hospital.
- Provided emotional support and comfort to families during difficult times.
- Monitored pre-authorization requests to verify complete information for service approvals.
- Reviewed proposed treatments for appropriateness and adherence to established criteria.
- Participated in interdisciplinary team meetings to discuss complex cases requiring authorization for specialized services or equipment.
Education
BSN Degree -
Western Governors University
Salt Lake City, UT02.2021
RN Degree -
Meridian Community College
Meridian, MS05.2006
Skills
- Electronic medical records management
- Report writing and analysis
- Effective communication skills
- Attention to detail
- Time management strategies
- EMR system proficiency
- Denial and appeals management
- Policy analysis expertise
- Claims and EOB review
Affiliations
- 2021-Present - Junior Auxiliary Volunteer serving the children of Newton County
Timeline
Registered Nurse
Trinity Health
07.2021 - Current
Remote Nurse Charge Auditor
Adreima/Nthrive/Savista
05.2013 - 07.2021
Field Nurse / Home Care Coordinator
Sta-Home Health and Hospice
07.2012 - 05.2013
Registered Nurse
Anderson’s Regional Medical Center
05.2006 - 07.2012
BSN Degree -
Western Governors University
RN Degree -
Meridian Community College
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