Lesley Campbell
New Port Richey
Summary
Knowledgeable Utilization Review Nurse with solid background in leading utilization review teams to enhance efficient healthcare delivery. Proven track record of implementing strategic review processes and improving care coordination. Demonstrated expertise in regulatory compliance and fostering collaborative environments to achieve organizational goals.
Overview
22
22
years of professional experience
Work History
Director of Utilization Review
Fairwinds Treatment Center
05.2008 - Current
- Implemented cost-saving measures without compromising quality of care by closely monitoring the use of resources during the review process.
- Evaluated the effectiveness of existing policies and procedures, recommending updates or revisions based on industry best practices.
- Collaborated with interdisciplinary teams, ensuring timely and accurate completion of utilization reviews for optimal patient care.
- Mentored junior team members, fostering a collaborative work environment that encouraged professional growth and development.
- Negotiated contracts with external vendors, securing favorable terms that benefited both parties while maintaining budgetary constraints.
- Developed targeted training programs to improve team performance and expertise in utilization review procedures.
- Presented findings from utilization reviews to executive leadership, informing decisions about resource allocation and organizational strategy.
- Stayed abreast of industry trends and emerging best practices in utilization management, incorporating relevant insights into departmental operations.
- Coordinated efforts between clinical staff, case managers, and insurance companies to ensure efficient communication throughout the review process.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Conducted comprehensive audits of past utilization reviews, identifying areas for improvement and implementing corrective actions.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Accounts Receivable Coordinator
Fairwinds Treatment Center
03.2003 - 07.2008
- Supported month-end closing procedures by reconciling accounts receivable ledgers and preparing aging reports for management review.
- Improved invoice accuracy by thoroughly reviewing billing data before issuing final statements.
- Expedited payment collection with timely submission of invoices and proactive communication with clients.
- Partnered with cross-functional departments to resolve discrepancies in customer accounts, promoting a cohesive work environment.
- Reduced outstanding debts through consistent follow-up on overdue invoices and negotiating payment plans.
- Posted customer payments by recording cash, checks, and credit card transactions.
- Verified discrepancies and resolved clients' billing issues
- Prepared bills receivable, invoices, and bank deposits.
- Processed incoming payments in accordance with established financial policies.
- Organized spaces, materials and catering support for internal and client-focused meetings.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
Education
Licensed Practical Nurse - Nursing
Galen School of Nursing
St. Petersburg02-2009
Skills
- Quality improvement
- Extensive background in eating disorder treatment
- Utilization management
- HIPAA compliance
- Discharge planning coordination
- Clinical assessment
- Inpatient care
- Reliability
- Outpatient care
- Documentation review
- Teamwork and collaboration
- Problem-solving
- Time management
Timeline
Director of Utilization Review
Fairwinds Treatment Center
05.2008 - Current
Accounts Receivable Coordinator
Fairwinds Treatment Center
03.2003 - 07.2008
Licensed Practical Nurse - Nursing
Galen School of Nursing
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