Lynna Williams
Lowell,AR
Summary
LPN, Medical Review Nurse with a proven track record as a Wal-Mart Vendor, enhancing claim resolution efficiency and ensuring regulatory compliance. Excelled in medical record review, clinical documentation, identifying discrepancies coupled with exceptional time management and adaptability to changing needs and reliability in delivering high-quality outcomes.
Overview
28
28
years of professional experience
Work History
Medical Review Nurse
Wal-Mart Vendor
05.1998 - Current
- Expedited appeals process for disputed claims by providing comprehensive assessments of clinical documentation supporting service requests.
- Facilitated timely claim resolution.
- Supported case management teams.
- Provided information for medical necessity determinations for various treatments.
- Improved overall efficiency by streamlining the review process, creating clear documentation, and developing strong communication channels.
- Maintained up-to-date knowledge of regulatory guidelines, ensuring adherence to industry standards throughout the review process.
- Enhanced review process by conducting thorough medical record reviews and identifying discrepancies or inconsistencies.
- Increased accuracy in billing processes by verifying correct coding practices within reviewed medical records.
- Contributed to cost containment efforts by identifying potential overpayments, underpayments, or fraudulent claims within reviewed cases.
- Determined services for patients in accordance with guidelines and regulations.
- Evaluated patient histories, complaints, and current symptoms.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Demonstrated leadership skills as a key member for quality improvement addressing identified areas of concern within the organization''s service delivery model.
Clinic Nurse
Fayetteville ENT Clinic
06.1996 - 06.1997
- Educated patients, families and caregivers about conditions and treatments.
- Coordinated referrals to specialists or external healthcare providers when necessary for specialized care.
- Assisted physicians during examinations and surgical procedures, providing expert clinical support as needed.
- Administered medications accurately, adhering to strict protocols and safety guidelines.
- Contributed to a positive work environment by collaborating effectively with colleagues and supporting team goals.
- Performed wound care procedures skillfully, preventing infection and promoting healing for timely recovery from injuries or surgeries.
- Managed inventory of medical supplies, maintaining adequate stock levels while minimizing waste.
- Safeguarded patient privacy by strictly adhering to HIPAA regulations when managing personal health information.
- Conducted health assessments to identify patient needs, leading to more accurate diagnoses and treatment plans.
Education
LPN - Nursing
Northwest Technical Institute
Springdale, ARSkills
- Medical record review
- Clinical Documentation
- Time management abilities
- Continuing education
- Healthcare regulations
- Utilization review
- Reliability
- Patient confidentiality
- Policy compliance
- Adaptability
Timeline
Medical Review Nurse
Wal-Mart Vendor
05.1998 - Current
Clinic Nurse
Fayetteville ENT Clinic
06.1996 - 06.1997
LPN - Nursing
Northwest Technical Institute
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