LINDSAY BODREE
Cantonment,FL
Summary
Enthusiastic Registered Nurse offering 20+ years of healthcare experience and eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of abstracting and interpreting pertinent medical documentation, coding and claims. Self-motivated professional accustomed to handling sensitive and confidential records while thriving in deadline-driven environments. Valued contributor focused on accurately capturing, storing, securing and wielding healthcare data.
Overview
15
15
years of professional experience
Work History
Utilization Review Nurse
Cohere Health
08.2021 - Current
- Perform 3.5-4 prior authorization review of services per hour requiring notification.
- Submit cases for criteria failures and helped facilitate resolutions and increase approvals.
- Evaluate medical guidelines and benefit coverage to determine appropriateness of services.
- Obtain authorizations from multiple insurance carriers for various levels of care.
- Perform prior-authorization reviews based for medical necessity based upon submitted CPT code(s)/procedure specification.
- Supervise and maintain all utilization review documentation through Cohere portal or CWQI.
- Follow all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Cardiovascular RN Health Coach
Cecelia Health
06.2019 - 07.2021
- Reported on clients' health status by interpreting data.
- Performed Medication Adherence forms every interaction
- Gathered health data from clients using self-assessment tools.
- Assessed/reported technical and non-technical adverse events within 24hr timeframe
- Enhanced awareness of health resources and worked to connect individuals with programs.
- Interpreted payer medical policies to determine eligibility for assistance with drug cost
- Completed annual Fraud, Waste and Abuse training
- Reported productivity analysis in Tableau
Pre Assessment/Quality Assurance Analyst
Andrews Institute
08.2009 - 05.2019
- Performed chart audits by applying medical criteria and clinical judgment to evaluate and establish determinations
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services, ensuring appropriate billing codes present
- Obtained Pre Authorizations
- Cultivated working partnerships with staff members, using feedback and clinical data to improve quality care and patient outcomes.
- Successfully led key projects which resulted in decreased waste/fraud
- Delivered exceptional level of service at public meetings by listening to concerns and answering questions.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Private Insurance Services to assign diagnostic codes.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Cardiovascular Cath Lab RN
West Florida Hospital
04.2009 - 08.2009
- Participated in hospital-wide initiatives and committees to improve patient care, satisfaction, safety and fraud prevention.
- Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management.
- Improved patient outcomes and quality of care by determining and suggesting changes to processes.
- Participated in hospital-wide initiatives and committees to improve patient care, satisfaction, safety and fraud prevention.
- Performed Cardiac clinical data abstractions on down time.
- Correctly coded and billed medical claims
- Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Registered Nurse
Sacred Heart Health
System
07.2008 - 04.2009
- Developed patient care plans, including overall patient health assessments and evaluations.
- Collaborated with physicians during medical rounds, updated treatment plans, and provided plan of care to patients and families.
- Entered orders into EMR system efficiently and without errors.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Reviewed patient charts to better understand health histories, diagnoses and treatments.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Applied charges and updated patient records by using McKesson and HST.
Education
Bachelor of Science - Nursing
Pensacola State College
Pensacola, FL2012
Associate of Science - Nursing
Pensacola Junior College
Pensacola, FL2004
Licensed Practical Nurse - Nursing
Pensacola Junior College
Pensacola, FL2002
Skills
- Strong Analytical skills to drive conclusions and results
- Strong organizational skills for prioritizing deadlines
- Proficient computer skills Microsoft, EHR's
- Data analysis, entry and review
- Troubleshooting/Problem Solving
- Medical Coding
- Multitasking Capabilities
- Records Analysis
- Interpersonal and Written Communication
- Attention to Detail
- Quality Improvement
- Flexible and Adaptable
Accomplishments
- Promoted to Charge RN~ Andrews Institute 2012-2019
- Developed and introduced protocol standards for new outpatient Total Joint program /assumed role as Total Joint Case Manager to review medical chart for completeness/medical necessity/approvals.
Timeline
Utilization Review Nurse
Cohere Health
08.2021 - Current
Cardiovascular RN Health Coach
Cecelia Health
06.2019 - 07.2021
Pre Assessment/Quality Assurance Analyst
Andrews Institute
08.2009 - 05.2019
Cardiovascular Cath Lab RN
West Florida Hospital
04.2009 - 08.2009
Registered Nurse
Sacred Heart Health
System
07.2008 - 04.2009
Bachelor of Science - Nursing
Pensacola State College
Associate of Science - Nursing
Pensacola Junior College
Licensed Practical Nurse - Nursing
Pensacola Junior College
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