Kristina Go Vogt
Wesley Chapel,FL
Summary
Hardworking and reliable Utilization/Denials specialist Nurse organized, proactive and punctual with team-oriented mentality.
Overview
16
16
years of professional experience
Work History
Denials Specialist
St Joseph Hospital-Baycare Health System
Tampa, FL
04.2024 - Current
- Monitored assigned accounts for payment resolution or appeal opportunities.
- Reviewed and evaluated claims to determine if they meet the insurance criteria for reimbursement.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Identified any discrepancies in patient information, provider information, or coding accuracy as part of the denial process.
- Utilized electronic medical records for accurate charting and reporting.
Surgical Review Nurse
St Joseph Hospital-Baycare health System
06.2023 - 04.2024
- Checks and reviews CPT codes and insurance authorizations to ensure appropriateness of requested services and procedures.
- Coordinated with physicians and other clinical staff to ensure patient is in the right admission status post surgery.
ER-Utilization Review Nurse
St Joseph Hospital-Baycare Health System
Tampa, FL
08.2019 - 06.2023
- Reviewed patient's admission to determine medical necessity as directed by criteria.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Collaborated with providers to obtain required clinical information, determinations and individual inquiries.
- Referred cases to secondary review for failure to meet InterQual criteria.
- Performed discharge planning including referrals for post-acute care services when appropriate.
- Developed case management plans based on individual patient needs and eligibility criteria.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Utilized electronic medical records for accurate charting and reporting.
RN Case Manager
St Joseph Hospital-Baycare health System
Tampa, FL
07.2014 - 08.2019
- Participated in quality improvement initiatives related to case management processes.
- Developed discharge plans for patients transitioning from acute care settings to home or alternate facilities.
- Collaborated with Physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
- Participated in interdisciplinary team meetings to coordinate care for complex cases.
- Reviewed physician orders for accuracy and completeness prior to implementation of service plan.
- Coordinated discharge planning to ensure smooth transition of care.
- Utilized electronic medical records for accurate charting and reporting.
- Referred patients to specialized health resources or community agencies to furnish additional assistance.
Registered Nurse
Heartland of Zephyrhills
Zephyrhills, FL
05.2008 - 03.2012
- Administered medications and treatments, monitoring patients for reactions and side effects.
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of medical team.
- Administered medications, tracked dosages, and documented patient conditions.
- Recorded patient condition, vital signs, recovery progress and medication side effects.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Registered Nurse, Cardiac Telemetry
St Joseph Hospital- Baycare Health System
Tampa, FL
12.2007 - 07.2014
- Administered medications as prescribed by physicians including intravenous drugs and monitored patient reactions.
- Collaborated with physicians regarding complex medical cases involving cardiac telemetry patients.
- Educated patients and families about the diagnosis, treatment plan, medications, lifestyle modifications and follow-up care.
- Served as a preceptor for new nurses entering the Cardiac Telemetry unit.
- Counseled patients and family members on topics such as diet, exercise regimens, risk factors or disease management.
- Assessed and monitored cardiac telemetry patients for changes in heart rhythm.
- Monitored vital signs including pulse oximetry readings and reported any abnormalities to attending physicians.
- Prioritized patient needs based on acuity and urgency levels.
- Coordinated discharge planning to ensure smooth transitions of care.
- Developed strong rapport with patients through active listening skills.
Education
Bachelor of Science - Nursing
BaycareBaCagayanycareBaycareBaycareLiceo De Cagayan University
Philippines03-2003
Skills
- Teamwork and Collaboration
- Time Management
- Professionalism
- Excellent Communication
- Time management abilities
- Skilled in Cerner and InterQual
Accomplishments
- Clinical Nurse Excellence Award June 2013
- Clinical Nurse Excellence Award 2015
Languages
Tagalog
Full Professional
Visayan
Professional
Timeline
Denials Specialist
St Joseph Hospital-Baycare Health System
04.2024 - Current
Surgical Review Nurse
St Joseph Hospital-Baycare health System
06.2023 - 04.2024
ER-Utilization Review Nurse
St Joseph Hospital-Baycare Health System
08.2019 - 06.2023
RN Case Manager
St Joseph Hospital-Baycare health System
07.2014 - 08.2019
Registered Nurse
Heartland of Zephyrhills
05.2008 - 03.2012
Registered Nurse, Cardiac Telemetry
St Joseph Hospital- Baycare Health System
12.2007 - 07.2014
Bachelor of Science - Nursing
BaycareBaCagayanycareBaycareBaycareLiceo De Cagayan University
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