Maria Gingras

• Co-own & operate Branches, where I also provide services as a board-certified RN Holistic Health & Wellness Coach & a Shamanic Practitioner (energy healer)/ Intuitive Medium
• As a health & wellness coach, I conduct comprehensive assessments of clients' physical, emotional, social, and spiritual health to develop individualized wellness plans based on their personal goals & desires
• Utilize evidence-based practices combined with holistic healing techniques (such as mindfulness, meditation, and nutrition) to address the whole person—body, mind, and Spirit.
• Provide one-on-one coaching and group education sessions to empower clients in areas such as stress management, healthy eating, energy medicine, connecting with intuition, healing trauma, natural remedies, meditation, etc.
• Monitor and evaluate client progress towards their health and wellness goals, adjusting plans and strategies as needed for optimal outcomes.
• Hold a safe, compassionate container to allow clients a space where they can become their most authentic selves; encouraging vulnerability, honesty, accountability & confidentiality in everything shared in our sessions
• Assist clients in identifying their health/wellness & lifestyle goals and transform old controlling habits into new empowering ways of living & being in the world. I help them to identify & shift limiting beliefs, insecurities & fears they feel may be holding them back from creating their healthiest life.
• Provide education on diet, exercise, mental & emotional health & natural remedies that provide healing support to the mind, body & Soul.
• Offer more specialized coaching programs such as Grief Recovery Coaching & Trauma Healing/Shadow Work Coaching; also Holistic in nature.
• Conduct ongoing research to stay informed of the latest developments in holistic health and wellness, integrating new findings into practice to enhance client care.
• Foster a supportive and empowering environment that encourages clients to take an active role in their health and wellness journey.
• Document client interactions, progress, and outcomes in a confidential and professional manner, ensuring compliance with healthcare regulations and privacy laws.
• As a Shamanic Practitioner & Intuitive Medium I deliver clients with healing messages from their Higher Selves/Compassionate Spirit Guides to empower a self-healing journey.
• Provide various forms of Shamanic energy healing modalities (such as Soul Retrieval, Psychopomp, Ancestral Clearing, Chakra Balancing & more) remotely, distantly & via in-person sessions.
• Intuitive Readings include but are not limited to: Akashic Records (past/parallel/potential future life information; Soul's Path/Purposes; Spirit/Angel/Star-Being/Galactic Family & Animal Communication; Mediumship w/ deceased loved ones; Aura/Body Scan; Medical Intuition; Energy Imbalances; Dream Interpretation; Psychometry; Spirit Guide/Power Animal Retrieval; Land Wisdom; Gifts of Spirit & more!

• Served as a lead role in the review of requested medical services, including making initial eligibility & coverage determinations, screening for medical necessity appropriateness, determining additional information required & referral to correct departments
• Performed clinical reviews to determine when services are medically necessary & appropriate; included development & management of documentation standards to achieve maximum care management outcomes
• Applied Change Healthcare's InterQual criteria to conduct initial & concurrent reviews & assist hospital case managers in facilitating appropriate/safe discharge plans for HPHC commercial members & STRIDE (Med-Advantage) population @ the inpatient level of care
• Sent complex cases for secondary review to HPHC Medical Directors and collaborated with the team to discuss plan of care
• Actively participated in team meetings & case conferences to identify issues, researched problems and developed/implemented solutions; worked effectively with other internal departments for problem identification and resolution
• Adhered to accreditation, contractual and regulatory timeframes in performing all utilization management review processes
• Developed and maintained effective working relationships with providers and as SME/Consultant for nurse care managers & other departments within HPHC
• Completed appeals requests and reviewed additional submitted documentation in response to prior denials to Providers

• Administered high-quality, compassionate nursing care to terminally ill & actively dying patients in both the home and facility settings
• Developed an appropriate plan of care with input from patients, families, MD's and interdisciplinary team members
• Performed "Start of Care" Admission assessments for newly admitted Hospice patients, re-visits for established patients & discharges and RN pronouncements for discharged or deceased patients
• Promoted the philosophy of Hospice care in both formal and informal settings
• Pro-actively advocated for patients and families during the dying process
  
• Participated in QIE Program
• Communicated with Hospice Medical Director, other treating MD's and families regarding patients' conditions
• Educated patients, families and caregivers on disease progression, end-of-life process, medications & treatments, pain & symptom management, hospice services/philosophy, patients rights
  

As a Client Policy Manager of Prospective Payment Accuracy in Medical Claims from Aug 2018-Jan 2019:

• Conducted research and analysis for medical policy items
• Reviewed clients' payment policies for accuracy
• Reviewed and identified changes needed to client policies in order to maintain up-to-date industry standards and accurate medical payment policies
• Provided direction on client understanding of medical policies
• Utilized various different software applications to review and analyze potential overpayment opportunities for the client
  

As an Auditor of Retrospective Payment Accuracy in Medical Claims from Oct 2016- Aug 2018:

• Identified potential claims outside of the current concept parameters
• Suggested & developed high quality, high value concept(s) and/or process improvement in medical claims auditing
• Assisted in the development of audit concepts
• Applied knowledge of Provider billing and patient accounting practices which may include industry references including CMS & The BCBS Association to reveal additional or enhanced overpayment recovery opportunities
• Reviewed and validated billing practices for inpatient and outpatient claims
• Responded or supplied support to facilitate and respond to client disputes for recoveries of concepts proposed; provided information which may include medical policy, coding variations, contract quotations to the client as required
• Integrated healthcare auditing principles and used objectivity in performance of medical audit activities and reviews
• Drew on healthcare proficiency and industry knowledge to substantiate conclusions
• Worked efficiently with a team, as well as independently to identify new recovery opportunities

As a per diem Registered Nurse from 2016-2018:

• Delivered quality nursing care to sub-acutely ill patients
• Provided palliative care to end-of-life patients
• Administered medications & provide wound care and treatments
• Admitted & discharged patients
• Completed daily Medicare notes and other appropriate nursing documentation
• Communicated and coordinated plans of care for patients with the interdisciplinary team  
• Scheduled, completed and transmitted MDS assessments to CMS in timely manner to ensure appropriate billing for fast-paced 19 bed transitional care unit

As The MDS Coordinator (LPN) 2015-2016:

• Scheduled, completed and transmitted all MDS assessments to CMS in timely manner to ensure appropriate billing for fast-paced 19 bed transitional care unit
• Performed in depth review of medical record/chart to properly code MDS and to ensure facility documentation policies were followed
• Improved the daily reimbursement rate through coordination of delivery of care involving cooperation between therapy and nursing services with the goal of attaining the highest RUG scores
• Provided all staff education pertaining to skilled nursing care and ADL documentation
• Tracked, measured, treated and documented all wounds on the TCU
• Communicated with physicians, nurses, certified nursing assistants, families and interdisciplinary team regarding patients' clinical conditions
• Ensured accurate ICD-10 coding
• Administered medications and treatments as a per diem floor nurse

• Exhibited detailed documentation skills in OBRA & PPS assessments and comprehensive care plans as an MDS Nurse from 2013-2015
• Developed and maintained on-going OBRA & PPS MDS schedules for residents
• Coordinated & facilitated interdisciplinary care plan meetings
• Completed medical record/chart & MDS audits
• Provided nurses and certified nursing assistants with training in daily documentation to ensure quality of care and reimbursement for the facility
• Floor nurse on a fast paced sub-acute care unit that also performed as the weekend supervisor for entire 122 bed facility from 2011-2013
• Delivered quality nursing care to 21 sub-acute & chronically ill patients
• Completed daily Medicare documentation, incident reports and employee reviews
• Delegated tasks to other nurses & certified nursing assistants
• Floor nurse on LTC unit from 2009-2011