Mary (Beth) Terrell

Reviewed medical records for clinical information to support appeal processes. Generate appeal reports for insurance claim denials including inpatient admissions, outpatient admissions, medications administered, imaging performed, behavioral health admissions, and skilled nursing facility admissions

• Prior Authorization nurse, Coordinate appeals.

• Perform prior authorization of inpatient services, outpatient services, durable medical equipment, prosthetics, home health services, medication services and health insurance claim review analysis. Perform inpatient/outpatient utilization management criteria reviews and utilization management criteria review for durable medical equipment, prosthetics, home health services, medication prior authorization. 16 years of multiple computer systems experience. Proficient in computer systems: Word, Outlook, McKesson/Interqual criteria guideline program, Milliman and Robertson criteria guideline program, CMS/Medicare criteria application, Power claim program, IDX claim program, Navigator claim system, and Cisco Unity phone system.
• Highlights of Contributions:
• Led organizational growth initiatives while serving as full-time utilization nurse in the prior authorization health services department.
• Facilitated cost management initiatives through effective utilization management of member services.
• Collaborated with multidisciplinary team members, working closely with physicians, nurses, technicians and therapists to formulate, implement and modify individual health care insurance needs.
• Enhanced positive public relations through dedicated efforts in treatment and personalized communication.
• Built solid, trusting relationships with co-workers and staff in multidisciplinary physician offices in the community and surrounding areas with health insurance coverage and healthcare utilization needs.
• Promote positive PR through extra efforts in treatment and one-on-one communications.

• And hospital/clinical staff nurse (9/1987 to 7/1999), with commendations for quality of total patient care from employers.
• Known as a loyal team player with an unwavering commitment to providing quality care and preventive medicine advocacy. Available for interview at your convenience and available for occasional travel for the right opportunity.
• Additional Information:

• Performed ICD-9 and CPT coding for emergency room and emergency room physician services all across the United States.
• Medical coding of for optimal billing and reimbursement of medical services rendered.
• Evaluated emergency room medical records for accuracy and compliance.
• Investigated medical services provided in the emergency room.
• Executed medical coding to maximize billing accuracy and reimbursement efficiency.

• Performed nursing duties as needed throughout a multidisciplinary medical clinic including routine patient care, assistance with surgical procedures and phone triage.
• Highlights of Contributions:
• Clinical evaluation of patient care needed.
• Provided nursing support across multiple departments.
• Performed ICD-9 and CPT coding to ensure accurate billing of medical services rendered.

• Performed nursing duties throughout a multidisciplinary medical clinic, including routine patient care, assistance with surgical procedures, and phone triage.
• Clinical evaluation of patient care needed.
• Assisted in multiple departments as a float nurse.
• Facilitated nursing coverage across different departments to enhance patient care.