LISA WIHLIDAL
Summary
Detail-oriented professional with extensive experience in medical documentation review and compliance verification. Proven ability to leverage critical analysis skills to identify discrepancies and ensure the highest level of accuracy. Adept at employing effective communication techniques to streamline processes and foster collaboration within teams. Committed to upholding industry standards while driving operational efficiency and quality improvement.
Overview
30
30
years of professional experience
Work History
Senior Medical Reviewer/Appeals Analyst
Palmetto GBA
05.2011 - Current
- Medical reviewer for Medicare Appeals claims in a work from home position.
- Extensive knowledge of government computer software programs such as; (FISS, IFlow, Appeals, HIMR, MAS, and Nurse Review
- Reviewed medical claims for compliance with regulatory standards and internal policies.
- Reviewed and analyzed medical records to ensure accuracy in claims processing.
- Ensured adherence to industry standards by staying current with changes in healthcare regulations.
- Identified trends in claims data, recommending process improvements to enhance efficiency.
- Displayed excellent multitasking abilities, managing simultaneous tasks while maintaining a high level of accuracy and attention to detail.
Staff RN
Columbia Eye Surgery Center/PRN
03.2010 - 05.2011
- Working in a PACU pre/post operative. Position in a local anesthesia setting.
- Responsible for history and physicals, phlebotomy and EKG's
- ACLS and BLS trained
- Overall nursing duties, and quarterly QA assignments and review
- Microsoft Office, Word, Quick Books, typing skills 80 wpm
Staff RN
Columbia Gastroenterology/PRN
10.2010 - 04.2011
- Working in a PACU pre/post operative setting
- Responsible for history and physicals, phlebotomy and EKG's
- ACLS and BLS trained
- Overall nursing duties, QA assignments
- G-Care computer system
Staff/Charge RN IICU
Providence Hospital
01.2003 - 01.2009
- Working in an intensive care setting
- Cardiac monitoring
- Ongoing critical care assessments of critically ill patients
- Responsible for history and physicals, assessments, phlebotomy and EKG's
- Duties delegation
- ACLS and BLS trained
- Microsoft Office, Word, Quick Books, typing skills 80 wpm
- Vents, trachs, G-tubes, wound care , and NG tubes, central lines
- All aspects of critical care nursing
Realtor
Russell & Jeffcoat Realtors
01.1999 - 01.2005
- Working as a Realtor handling all transactions directly related to selling and purchasing of residential properties and land
- Home staging and interior design
Nurse Manager/Charge Nurse
South Carolina State Government
01.1996 - 01.1999
- Management of a 44 bed geriatric/psychiatric unit with a staff of 20
- All aspects of nursing care as well as independent assessment skills, transcribing orders, team meetings and treatments
- Responsible for delegating duties, and overall floor management
- Case management , care plans, patient quarterly reviews
- Care Plans
- Team meetings
Education
Diploma - RN 3-year Diploma Program
Durham College
Oshawa, Ontario01.1995
Skills
- TEFL certification, 2025
- Commitment to ethical standards
- Consistent reliability
- Strong verbal communication
- Effective communication
- Adaptability to change
- Verbal and written communication
Languages
English
Native or Bilingual
French
Native or Bilingual
Hobbies and Interests
Puzzles, movies, TV series, history, and travel.
Timeline
Senior Medical Reviewer/Appeals Analyst
Palmetto GBA
05.2011 - Current
Staff RN
Columbia Gastroenterology/PRN
10.2010 - 04.2011
Staff RN
Columbia Eye Surgery Center/PRN
03.2010 - 05.2011
Staff/Charge RN IICU
Providence Hospital
01.2003 - 01.2009
Realtor
Russell & Jeffcoat Realtors
01.1999 - 01.2005
Nurse Manager/Charge Nurse
South Carolina State Government
01.1996 - 01.1999
Diploma - RN 3-year Diploma Program
Durham College
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